United States General Accounting Office

GAO Report to Congressional Requesters

November 1999 EDUCATION AND

CARE

Early Childhood

Programs and Services

for Low-Income

Families

GAO/HEHS-00-11

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-281005 

November 15, 1999

The Honorable Judd Gregg

Chairman, Subcommittee on Children and Families

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable William Goodling

Chairman, Committee on Education

 and the Workforce

House of Representatives

The Honorable Michael N. Castle

Chairman, Subcommittee on Early Childhood,

 Youth, and Families

Committee on Education and the Workforce

House of Representatives

Billions of federal and state dollars annually support multiple programs to

address the early childhood care and education needs of low-income

families. Information from these programs on the availability and

accessibility of care and services that children receive is of great interest

for several reasons.1

 Recent developments in the 1996 welfare reform

legislation require more welfare families, including those with very young

children, to find and keep jobs. Also, much attention has been given to the

relationship between child care experiences and school readiness. Finally,

the existence of multiple funding sources for early childhood care and

education has increased some states’ interest in using program

collaboration.

Recently, a number of congressional proposals have been made to

increase federal child care funding. Therefore, you asked us to describe

(1) programs and services funded at the federal and state levels that

directly provide early childhood care and education for the general

population of low-income children up to age 5, (2) state and local

assessments of the relative difficulty low-income parents face in obtaining

care for their children, and (3) the collaborative efforts among child care

officials and early childhood education officials to address these parents’

difficulties. Much of our data came from a survey of child care

1

In this report, “early childhood care and education” includes care that is provided to low-income

children whose parents are out of the home in work activities and who may be in a center or a home,

as well as care that is focused on a child’s education, such as care that preschools and Head Start

provide.

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administrators and departments of education in all 50 states and the

District of Columbia and from a survey of all 537 child care resource and

referral agencies in the membership database of the National Association

of Child Care Resource and Referral Agencies (NACCRRA).2

 We also visited

Colorado, North Carolina, Ohio, and Oregon, which the National

Governors Association had identified as leaders in collaborative efforts for

early childhood care and education, and we visited two counties, one

mostly rural and one mostly urban, in each of these states. We interviewed

program officials at all levels and early childhood researchers, and we

reviewed related reports of research organizations. We did work in

accordance with generally accepted government auditing standards

between August 1998 and October 1999. (See appendix I for more details

on our methodology.)

Results in Brief The federal government invested about $11 billion in FY 1999 on early

childhood care and education programs for low-income children through a

range of programs and the states invested almost $4 billion for such

programs.3

 The Department of Health and Human Services (HHS) provides

most of the federal support for early childhood care and education, about

$8 billion, through the Head Start program and the Child Care and

Development Fund (CCDF), which subsidizes the child care expenses of

low-income working parents. Other HHS and Department of Education

programs provide the remaining funding for early childhood care and

education. Thirty-two states reported funding preschool programs, 15

states reported providing state money to supplement Head Start, and 19

states reported child care programs that provided funding to communities.

Our survey results showed that educationally oriented services (for

example, numeracy and literacy activities) were the most common

services providers offered in centers and homes. Providers were less likely

to include other services, such as family social services or medical

referrals.

2

NACCRRA’s membership database contains 537 of an estimated 800 agencies nationwide.

3

We included only major programs that low-income parents can use to obtain child care. For the total

federal funding figure, we included only programs that directly provide (1) child care or education or

(2) funds to provide child care and education for low-income children up to age 5. We did not include

programs that support but do not provide funding for child care, such as the U.S. Department of

Agriculture’s Child and Adult Food program, child care tax expenditures at the federal and state levels,

programs with a limited eligibility, or the Stewart B. McKinney Homeless Assistance Act. For a

detailed list of other sources of federal funding available for child care, see Federal Child Care Funding

(GAO/HEHS-98-70R, Jan. 23, 1998). The $4 billion figure for state funding represents data from our

survey on state expenditures. This does not represent the entire state investment but it does reflect

state contributions for programs within the scope of our review.

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Although a number of federal and state programs provided significant

funds for early childhood care and education, some types of child care

were still difficult for low-income families to obtain, including infant and

toddler care; care for children who have special needs, such as children

with physical disabilities; and care for children during nonstandard hours

(evenings and weekends). In contrast, a majority of the survey

respondents indicated that care for 3- and 4-year-olds was generally not

difficult to obtain. Child care administrators identified three major barriers

to finding care for low-income children—cost of care, especially for

infants and toddlers; availability; and accessibility, such as transportation

to get to providers, described as more difficult in rural and remote areas.

Some states and localities are using collaborative initiatives to better

bridge child care programs and early childhood education programs as

well as the federal and state programs. During our visits to Colorado,

North Carolina, Ohio, and Oregon, officials at all levels reported that

collaboration among child care and early childhood education program

officials and nonprofit organizations improved the availability of education

and care services for low-income families and enhanced the quality of

care. Officials from these states reported using in these collaborative

efforts similar strategies to provide incentives for local collaboration, such

as additional funding. For example, in Ohio CCDF and Head Start officials

pool resources by sharing staff to add full day care to the half-day Head

Start program and to add Head Start services, such as nutrition and

medical care, to day care programs. All the states we visited reported

increased availability of full-time care for 3-to-5-year-olds as a result of

collaborative efforts and more limited success in increasing the availability

of infant and toddler care or care during nonstandard hours. However,

barriers to collaboration still remain, according to state officials and

survey respondents. Factors they identified as impeding collaboration

included differing eligibility requirements; “turf” issues, such as concerns

about losing program authority; lack of information on different programs;

and the lack of funding to support collaborative activities. These barriers

generally reflect the division between the child care and early childhood

education communities.

The types of care that currently have the greatest need for support are

infant and toddler care, care during nonstandard hours, and care for

children with special needs. In the states we visited, collaborative efforts

have yielded some positive results in addressing child care and education

needs. Information on them may be useful to other states and

communities.

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Background Early childhood care and education are generally provided in three types

of settings: in the child’s home, in the home of a provider, and in a center

or other nonresidential setting. Providers in a home setting that are

regulated by the state are required to meet certain operating standards

established by state or local governments, such as a maximum number of

children per staff. Unregulated providers may or may not meet such

standards. Most care provided in centers is regulated, although some

states exempt centers if they are sponsored by a religious group or

government entity. Further, within a particular setting—whether a home

or a center—the specific services provided can range from solely child

care assistance to a full continuum of services such as children’s

educational activities, immunization referrals, and developmental

assessments and parental literacy and job training, referrals to social

services, and parenting-skill training.

Historically, early childhood care programs and early childhood education

programs have existed as separate systems with different goals. The

primary goal of child care programs has been to subsidize the cost of care

for low-income parents who are working or engaged in education and

training activities. At the federal level, child care is primarily supported by

CCDF. In contrast, early childhood education programs have generally

focused on helping children become ready to begin school. The largest

such program is Head Start. This split is also reflected at the state level in

child care subsidy programs and preschool programs.

The Personal Responsibility and Work Opportunity Reconciliation Act of

1996 (P.L. 104-193) is directed at increasing low-income families’ reliance

on work rather than welfare. This legislation established Temporary

Assistance for Needy Families (TANF), a program designed to help welfare

recipients move into the workforce. Previously, under Aid to Families with

Dependent Children, most states exempted single parents with children

younger than 3 from participating in education, training, or work-related

activities. However, under the new welfare reform legislation, most states

exempt only single parents with very young children, and most recipients

are now required to participate in work or work-related activities.4

 In

addition, increased emphasis on moving people off welfare and into work

activities may result in parents with low skills being employed in

4

TANF has no exemption based on the age of children but allows states to exempt parents with

children younger than 1. Twenty-four states exempt parents with children up to 1 year of age, 15 states

exempt parents with children 6 months of age or younger, and 4 have no exemption related to

children’s ages. Two states allow counties to set the exemption age. The 5 other states have

exemptions at various ages older than 1 year. In addition, the states may not reduce or terminate

assistance to a single custodial parent of a child younger than 6 who has demonstrated the inability (as

determined by the state) to obtain needed child care.

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evening-shift and weekend work activities. As a consequence, this

legislation could increase the demand for some types of child care,

specifically infant and toddler care and nonstandard hour care, for both

families on welfare and those moving into the workforce.5

Concern over the kind of services low-income children receive while their

parents work has been underscored by research. Although the relative

importance of recent neurological research on early brain development is

controversial, a large body of research from child development experts

and quality-of-care studies indicates that developmentally appropriate

experiences for very young children are beneficial. In addition, concern in

many states over the number of children who arrive in school with poorly

developed skills necessary for learning, such as fine motor and general

cognitive skills as well as social skills, adds to the interest in what kind of

care and services are most effective for school readiness.

Federal and State

Government

Programs Fund a

Variety of Early

Childhood Care and

Education Services

In 1999, the federal government provided approximately $11 billion

through multiple programs administered by HHS and Education to fund a

variety of early childhood care and education services—mostly targeted to

low-income children. In addition, many states support care and education

by funding preschool programs and providing grants to communities to

increase the supply of child care. These programs are often targeted to a

specific population, such as children up to 3 or 3- and 4-year-olds from

low-income families. Our surveys of state child care administrators and

resource and referral agencies provide information on the variety of

services offered in home and center settings. These services most often

focus on educational activities but also occasionally include meals,

immunization referrals, parental support services, and social service

referrals.

Head Start and CCDF

Provide Most Support for

Early Childhood Care and

Education

Of the $11 billion in federal support for early childhood care and education

for low-income children, almost $8 billion is provided through Head Start

and CCDF, as shown in table 1.

5

See Welfare Reform: Implications of Increased Work Participation for Child Care (GAO/HEHS-97-75,

May 29, 1997) and Welfare Reform: States’ Efforts to Expand Child Care Programs (GAO/HEHS-98-27,

Jun. 13, 1998), for a more complete discussion of welfare reform and child care.

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Table 1: Major Federal Programs That

Funded Early Childhood Care and

Education for Low-Income Children in

Fiscal Year 1999

Program Target age Department

Funding in

millions

Head Start $4,660

Early Head Start Birth to 3 HHS 349.4

CCDF Birth to 12a HHS 3,167

TANF

Funds transferred to CCDF Birth to 12 HHS 636b

Funds used for child care Not specified HHS 259b

Social Services Block Grants Not specified HHS 285c

Title I, part A Pre-K through 12 Education 936d

Individuals with Disabilities

Education Act

Preschool Grants 3 to 5 Education 374

Grants for Infants and

Families with Disabilities

Birth to 2 Education

370

Even Start Birth through 8 Education 135

21st Century Learning Centers All Education 200

aAccording to HHS, it does not track the amount of funds spent by age group, including birth to 5

years.

bFigure is for fiscal year 1998.

cTotal fiscal year 1999 appropriation was $1.9 billion. The states have historically reported

spending on average about $285 million from Social Services Block Grants on child care, or

15 percent.

dTotal fiscal year 1999 appropriation was $7.8 billion. In previous years, an estimated

$156 million, or 2 percent, supported pre-K programs and $936 million, or 12 percent, supported

pre-K and kindergarten children.

Head Start, established in 1965, focuses on providing early childhood

education and developmental services for low-income preschool children

and their families through grants to local agencies. Specifically, services

for children focus on education (such as literacy activities),

socioemotional development (such as activities developing self-concept),

physical and mental health (such as immunizations), and nutrition (such

as meal and nutrition awareness). The program also provides some

parental support services (such as, referrals to social services). Head Start

primarily serves 3- and 4-year-olds in part-day and full-day programs.6

 At

least 90 percent of the children enrolled in a program must come from

families whose income is at or below the federal poverty line or who are

6

In Head Start Programs: Participant Characteristics, Services, and Funding (GAO/HEHS-98-65), we

reported that 93 percent of the children were in part-day and part-year programs and 63 percent were 4

years old.

Page 6 GAO/HEHS-00-11 Low-Income Childhood Care
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receiving public assistance.7 In fiscal year 1999, an estimated 1,520

grantees participated in Head Start, serving slightly more than 831,000

children. Early Head Start, which began in 1995, was designed to enhance

the development of infants and toddlers and to promote healthy family

functioning and healthy prenatal outcomes for pregnant women. For fiscal

year 1999, the Congress earmarked $349.4 million for Early Head Start.

The program reports having served 39,000 infants and toddlers in that

year.

The other major HHS program is CCDF, which in fiscal year 1999 provided

$3.2 billion to states to subsidize child care expenses for children younger

than 13 in low-income working families. Federal law allows the states to

use CCDF to help working families or families preparing for work with an

income of less than 85 percent of the state median income. In practice,

however, many states establish lower income eligibility levels. Federal

regulations also require that the states target a portion of CCDF funds to

welfare recipients working toward self-sufficiency or to families at risk of

welfare dependency and that they use at least 4 percent of their total CCDF

funds for quality improvements and offer additional services to parents.8

CCDF funds subsidize child care through certificates that parents can use to

pay the child care providers they select. Some states also use contracts to

fund slots in child care programs. Preliminary HHS data over the 6-month

period January to June 1997 indicate that voucher use was fairly evenly

split between home and center settings.9

Other HHS and Education programs also support child care and education

in various ways, sometimes with different program goals. For example,

HHS’s TANF program provided about $900 million for child care in fiscal year

1999 to support parents in work activities. In addition, Social Services

Block Grants (SSBG) is a flexible source of funds that the states may use to

support a wide variety of social services, including child care. In

Education, the Even Start program has adult literacy and parenting

education, as well as early childhood care and education for children

through 8 as goals. This program is funded with $135 million and serves

7

According to 1999 HHS guidelines, $13,880 per year for a family of three is the federal poverty level for

the 48 contiguous states and the District of Columbia; the level is higher in Alaska and Hawaii.

8

Additional services to parents include services such as resource and referral counseling regarding the

selection of appropriate child care. In addition, for fiscal year 2000, the Congress has established

several earmarks above the 4 percent minimum quality expenditure requirement—$173 million for

quality activities, $50 million for improving the quality of infant and toddler care, and $19 million for

child care resource and referral and school-age child care activities.

9

Preliminary data on types of care being used by children subsidized by block grants indicate that on

average about 11 percent of the children are cared for in home, 30 percent are with family child care,

4 percent are with group homes, and 55 percent are using centers.

Page 7 GAO/HEHS-00-11 Low-Income Childhood Care
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about 40,000 families. In addition, title I of the Elementary and Secondary

Education Act supports programs and services for educationally

disadvantaged children; funding for early childhood education is estimated

to have been about 12 percent, or $936 million, of the total $7.8 billion in

fiscal year 1999. The Individuals with Disabilities Education Act (IDEA),

another Education program, has a Grants for Infants and Families with

Disabilities program. Services such as speech therapy are provided to

assist the states in creating statewide systems of programs to make

available early intervention services to all children with disabilities aged

birth through 2 years old and their families at home or in whatever early

childhood care or education setting children attend. The IDEA Preschool

Grants program provides states with funding to enable children with

disabilities to receive special education and related services for preschool

children. Finally, 21st Century Community Learning Centers may support

early childhood care and education. The $200 million program funds

school-community partnerships to keep schools open after school and in

summer as a safe haven for enhanced learning.

Most States Fund Early

Childhood Programs

Forty-three states, including the District of Columbia, reported that in

fiscal year 1999 they provided their own state funding, beyond the

amounts required to match federal contributions, to support early

childhood programs.10 Table 2 provides information on funding and

enrollment in such programs.

Table 2: Types of Programs States

Funded in Fiscal Year 1999

Type Number of statesa Estimated funding

Number of

children

Early childhood education 32 $1.7 billion 613,000

Child care program

supplements 19 1.7 billion 351,000

Head Start supplements 15 155 million 48,000

aSome states supported more than one type of program, but in total 43 states had at least one.

Thirty-two states reported funding preschool programs that generally

operated as part of the public school system. Also, 15 states provided

funds to supplement the Head Start program by expanding it to serve more

children, by increasing teacher salaries, or by providing transportation to

Head Start facilities. Finally, 19 states administered programs that helped

10In order to draw down their federal allotments, the states must meet a maintenance of effort

requirement and contribute matching funds. We excluded programs funded by a state match and

programs with a limited eligibility, such as programs only for teenagers.

Page 8 GAO/HEHS-00-11 Low-Income Childhood Care
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fund child care for communities by providing grants to communities to

address their child care needs. These funds could be used in a variety of

ways, such as for preschools, for child care, to give providers training, and

for assistance in meeting licensing requirements. Of the 43 states, 20

provided some funding for infant and toddler care, generally through funds

to communities. The number of children served by state early childhood

care and education programs ranged from several hundred in five states to

nearly 140,000 in Texas.

Education Is the Most

Frequently Provided

Service

Resource and referral agencies reported in responding to our survey that

providers in home and center settings offered a range of services, but

educational programs in centers were by far the most common, as shown

in figure 1. The proportion of providers offering other services was much

lower. Generally, centers provided more services than were provided in

homes. For instance, about 10 percent of the resource and referral agency

respondents stated that all or most centers provided parental support

services or medical referrals; fewer agencies reported that all or most

home care settings provided these same services. According to census

data, about 70 percent of low-income families met their child care needs in

the home.

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Figure 1: Percentage of Providers That

Offer Services as Reported by

Resource and Referral Agencies

0 10 20 30 40 50 60 70 80 90

Family Social Services

Parental Support

Medical Services and

Referrals

Referral for Emergency

Food Supplies

Education

Percentage

Center-Care Settings

Providers

Home-Care Settings

Similarly, our survey of state child care administrators showed that most

state-funded programs offered educational services. In addition, most also

offered parental support activities, meals for the children enrolled, and

referrals for medical services.

Some Types of Care

Are Difficult to Obtain

Although the federal and state governments support many programs for

early childhood care and education for low-income children, some types of

care such as infant and toddler care are still difficult to obtain. State child

care administrators reported that the high cost of care, its unavailability,

and inaccessibility to providers were significant barriers to low-income

families in obtaining the types of care they needed.

Collectively, our surveys, which covered all states and many communities

across the country, showed that obtaining care for infants and toddlers,

for children with special needs, and during certain hours posed the most

difficulty for low-income families. Figure 2 shows the responses on the

difficulty of obtaining different types of care from the resource and

referral agency survey; the responses of the child care administrators

Page 10 GAO/HEHS-00-11 Low-Income Childhood Care
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identified similar difficulties. Our previous work, based on limited case

studies, also identified obtaining care as a problem for infants and

toddlers.11 Resource and referral survey responses, however, reported that

care for preschool children generally was not difficult to find.12 Slightly

more than half of child care administrators reported that there was

sufficient full-time care for preschoolers. Respondents provided additional

comments on the difficulties in obtaining care. For example, they reported

that finding one place that provided care for children of different ages in

the same family such as an infant and a preschooler was difficult. The

need for infant care and care during nonstandard hours may be

particularly important for TANF recipients. According to a recent study,

more than a quarter of former welfare recipients and a similar proportion

of low-income mothers work night hours.13

11See Welfare to Work: Child Care Assistance Limited; Welfare Reform May Expand Needs

(GAO/HEHS-95-220), and GAO/HEHS-98-27.

12Our survey does not reflect whether or not the care available is considered quality care.

13“Assessing the New Federalism: An Urban Institute Program to Assess Changing Social Policies,”

discussion paper, Urban Institute, Washington, D.C., 1999.

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Figure 2: Percentage of Resource and

Referral Agencies Reporting That Care

Is Difficult or Very Difficult to Obtain

0

10

20

30

40

50

60

70

80

90 Percentage

Evenings,

Nights, or Weekends

Infant and Toddler

Special Needs or Disabilities

For Mild Illness

In Rural Areas

Part-Time

In Suburban Areas

In Urban Areas

Preschool

Full-Time

Type of Care

Child care administrators reported that high cost is a barrier, whether

parents are seeking care for preschoolers or care for infants and toddlers.

Care for infants and toddlers is generally more costly than preschool care

mainly because of the higher staff-to-child ratio required. The subsidy

provided in states does not always cover the cost of available care for

infants and toddlers. Resource and referral agencies reported in our

survey that about 80 percent of their centers and 70 percent of their home

care providers accepted children with subsidies. Smaller subsidies allow

states to provide subsidies to more families but can limit the families’

ability to find affordable care. For example, officials in Colorado estimated

that the average child care assistance subsidy is just 62 percent of the cost

of quality care.

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More than half of the state child care administrators cited the

inaccessibility of care, often related to transportation difficulties, as

another major barrier to low-income families seeking child care.

Transportation was especially problematic in rural areas. For preschool

care, arrangements sometimes have to be made to move children from a

half-day educational program to a supplementary care program for the rest

of the day.

Collaboration Has

Positive Outcomes

but Barriers Remain

To address the difficulties in obtaining certain types of care, states and

localities are using collaborative initiatives to bring together the different

program authorities involved in funding and providing care, with the goals

of increasing the availability of various types of care and enhancing the

services provided. However, according to state officials, collaboration

does not eliminate all gaps in care, and collaborative initiatives are

sometimes limited because of barriers such as differing eligibility

requirements.

States Reported That

Collaborative Initiatives

Have Resulted in Positive

Outcomes

In Colorado, Ohio, North Carolina, and Oregon, collaborative efforts

combined state and federal funds from a variety of sources to increase the

availability of child care and education settings available to low-income

families. Collaboration was usually accomplished through interagency

coalitions or organizations that tried to fit together different care and

education options to meet communities’ and parents’ needs. These states

also offered communities incentives to collaborate, either in the form of

waivers to state regulations or as additional funds. Some of the efforts

were enhanced by Head Start collaboration grants to local grantees.

Child Care and Education

Collaborative Initiatives

Implemented in Four States

In Colorado, the state legislature created the Community Consolidated

Child Care Pilot Program to encourage communities to design

consolidated programs of comprehensive early childhood care and

education services for children in low-income families aged 6 weeks

through 5 years old. At a minimum, pilot communities were required to

consolidate funding from the Colorado Preschool Program, operated

under the authority of local school districts and child care money

administered by local boards of county commissioners, thereby

encouraging the education and child care systems to come together.

Initially, the legislature provided no financial incentives to encourage pilot

counties to collaborate; however, in future years, additional funds will be

made available to enable the collaborations to further increase child care

availability.

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The Colorado legislature authorized the state Department of Human

Services to waive state laws or rules that would prevent the pilot

communities from implementing collaborative projects. Waivers included

requiring only a single application for multiple programs and broadening

program eligibility to meet specific community needs. For example, two

pilot counties raised the income eligibility level for the state child care

subsidy so that low-income working parents’ child care expenses would

not increase substantially as their income increased.

North Carolina’s Smart Start initiative provided state funds ($24.4 million

in 1998) to assist communities in improving and expanding their existing

programs for children and families and in designing and implementing new

programs. The primary goal of Smart Start is to ensure that North

Carolina’s children enter school healthy and ready to learn. A prerequisite

for the receipt of Smart Start funds is that representatives from various

community organizations must form local partnerships for children to plan

for and direct the distribution of the funds to local service providers.

Initially funding twelve partnerships, Smart Start partnerships now

operate throughout the state. Local partnerships were funded both to

increase the availability of child care and to improve center or provider

quality.

Created in 1992, Ohio’s Family and Children First Initiative focuses a

diverse group of agencies and organizations on achieving better outcomes

for children and their families. The goal is to promote collaboration among

state and local governments, nonprofit organizations, businesses, and

families to ensure that children are ready to learn. Its three key objectives

are making infants healthier, increasing access to quality preschool and

child care, and improving services for family stability. The Early

Childhood Coordination Committee is charged with bringing Ohio’s Head

Start program, Ohio’s public preschool program, and its subsidized child

care program into a coordinated system of care. At the county level, the

initiative has supported the funding and development of councils

composed of several child care organizations, including both child care

programs and education programs. Each county council received a $20,000

state grant for these collaboration activities. Ohio also provided

$181 million in state funds to expand Head Start services to more eligible

families. Further, by combining Head Start with CCDF funds, the state has

enabled children in poor working families to receive a full day of care.

In 1993, Oregon’s legislature created the Commission on Children and

Families to support community-based planning and decisionmaking and to

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encourage collaborative partnerships to change the state’s system of

delivering services and develop supports for children and families. Local

commissions were to include citizens, community groups, businesses,

service providers, and government. In 1997, the commission directed

$58.4 million, primarily from state and federal government sources, to the

local commissions on children and families in each of its 36 counties.

Collaboration among different programs operating in the community was a

prerequisite for receiving a grant.

Head Start Support for

Collaboration

Collaborative efforts were also being fostered through federal programs.

For example, in 1990, HHS began to award collaboration grants to a few

states to promote more integrated service delivery systems and to

encourage collaboration between Head Start and other programs. By 1997,

all states were funded. The Congress also increased funding for Head Start

for fiscal years 1998-99, in part to increase enrollment numbers.

Recognizing that an increasing proportion of Head Start families work and

that many who receive public assistance are participating in welfare

reform initiatives in response to TANF, HHS gave priority to funding more

full-day, full-year care. Head Start encouraged programs to consider

combining Head Start expansion funds with other child care and early

childhood funding sources to deliver services through partnerships such

as community-based child care centers. In addition, the 1998 amendments

encouraged collaboration and have resulted in a performance indicator,

the measure by which Head Start grantees are evaluated, that indicates the

extent to which a Head Start grantee is collaborating with other

community providers in providing linkages to child care.

Positive Outcomes Reported As a result of these initiatives, the states reported positive outcomes in

terms of increased child care and services. Colorado officials reported a

larger increase in the number of children served in pilot counties than

elsewhere in the state. For example, according to the director of one pilot

collaboration project, the project’s efforts have enabled it to increase child

care by 61 percent and to essentially meet the need for care and education

for 3- to 5-year-olds. Similarly, Ohio reported that the collaboration

between state and federal Head Start and Ohio preschool and child care

programs has enabled Ohio to increase not only the amount of care

available to low-income children but also their access to Head Start

services. The state reported that it currently serves 84 percent of its

children who are eligible for Head Start in state or federal Head Start

programs, compared with a national average of 38 percent. In North

Carolina, an evaluation of the Smart Start program reported a 12 percent

increase in credentialed child care providers. Officials in one county

Page 15 GAO/HEHS-00-11 Low-Income Childhood Care
B-281005 

credited Smart Start with a 25 percent increase in the number of child care

centers meeting the state’s highest standard for center-based care.

Likewise, state officials in Oregon identified positive outcomes that have

resulted from its collaborative efforts, including increased numbers of

preschool programs, licensed providers, and home-based care for infants

and toddlers and the initiation of a career development program for

providers. Oregon also reported that it increased the number of group

homes by 25 percent.

Barriers to Collaboration Collaboration has, according to state officials, clearly resulted in positive

outcomes; however, barriers to collaboration still remain. State program

administrators and resource and referral agency respondents identified

several barriers, including differing eligibility requirements, “turf” issues or

concerns that an official’s authority or power would be lessened,

insufficient funds, and lack of information on programs. Program

administrators said that the differing eligibility requirements between

Head Start and CCDF made collaboration difficult. Head Start’s income

eligibility standard requires that 90 percent of enrollments be at or below

the federal poverty level, whereas CCDF funds may be used for families

with income up to 85 percent of state median income, which generally

allows the states to give subsidies to families who make more than the

federal poverty level. Thus, collaboration between these programs to

achieve objectives, such as full day coverage, might be difficult because

some children may be eligible only for CCDF.

In citing turf issues as barriers to collaboration, the respondents expressed

concern that officials’ power or authority would be reduced and that they

would be unwilling to share program funds. These issues often reflected

the division of child care organizations from early childhood education

organizations. Child care programs were generally administered through

human services agencies, whereas preschool education programs were

generally administered by the education departments and public school

agencies. One state official said that with the separate funding,

regulations, and goals, the child care and education offices have not

traditionally understood the importance of each other’s role in a child’s

development.

Resource and referral agency and state administrator respondents also

frequently cited a lack of information on the various programs that fund

child care and education as a barrier to collaboration. For example, one

respondent commented that a lack of understanding of the different

Page 16 GAO/HEHS-00-11 Low-Income Childhood Care
B-281005 

agencies’ and organizations’ policies and service delivery hindered

collaboration. In one state, an official told us that the people who work in

child care do not know the requirements for facilities and training that

exist in the education department and that are very different from theirs

and vice versa.

Respondents reported that insufficient funds also hindered their ability to

collaborate. Lack of funding to support collaborative initiatives was widely

cited as a barrier, with respondents specifically citing a lack of staff,

training, and transportation as hampering collaboration with other

organizations.

Conclusions The implementation of TANF has put more low-income children in care

outside the home and put them in care earlier in their lives. While efforts

to provide programs of care for preschool children appear to generally

meet the demand for such care, care for infants and toddlers, care during

nonstandard hours, and care for children who have special needs are still

not available, affordable, or accessible. As a result, these are the types of

care most in need of support. Some states and localities have been using

collaborative initiatives to increase the number of full-day providers and to

enhance the quality of program services, and these have positively

addressed families’ and children’s needs. The methods they have used may

be helpful to other states and localities as they attempt to address their

own needs.

Agency Comments We provided Education and HHS with a draft of this report for their review.

HHS responded with comments that are printed in appendix II. In its

comments, HHS wrote that this report will be helpful as it continues its

efforts to work with states and communities to meet the needs of

low-income preschool children and their families. HHS fully supports our

conclusions about the need for care for working low-income families. It

provided additional information about the types of care and the adequacy

of the care it says is needed, as well as descriptions of various initiatives to

support collaborative efforts to meet such needs.

At our meeting with Education officials, including representatives from

different Education program offices, Education said that it generally

agrees with our findings and conclusions. In addition, Education provided

us with information about its ongoing and planned efforts to promote

Page 17 GAO/HEHS-00-11 Low-Income Childhood Care
B-281005 

literacy and coordination with other programs. Where appropriate, we

made technical changes that both departments provided.

We are sending copies of this report to the Honorable Donna E. Shalala,

Secretary of the Department of Health and Human Services; the Honorable

Richard W. Riley, Secretary of the Department of Education; and others

who are interested. We will also make copies available to others upon

request.

If you or your staff have any questions about this report, please contact me

on (202) 512-7215. Other staff who contributed to this report are listed in

appendix III.

Cynthia M. Fagnoni

Director, Education, Workforce, and

 Income Security Issues

Page 18 GAO/HEHS-00-11 Low-Income Childhood Care
Page 19 GAO/HEHS-00-11 Low-Income Childhood Care
Contents

Letter 1

Appendix I 

Scope and

Methodology

22

Appendix II 

Comments From the

Department of Health

and Human Services

24

Appendix III 

GAO Contacts and

Staff

Acknowledgments

29

Tables Table 1: Major Federal Programs That Funded Early Childhood

Care and Education for Low-Income Children in Fiscal Year 1999

6

Table 2: Types of Programs States Funded in Fiscal Year 1999 8

Figures Figure 1: Percentage of Providers That Offer Services as

Reported by Resource and Referral Agencies

10

Figure 2: Percentage of Resource and Referral Agencies

Reporting That Care Is Difficult or Very Difficult to Obtain

12

Abbreviations

CCDF Child Care and Development Fund

HHS Department of Health and Human Services

IDEA Individuals with Disabilities Education Act

NACCRRA National Association of Child Care Resource and Referral

Agencies

SSBG Social Services Block Grants

TANF Temporary Assistance for Needy Families

Page 20 GAO/HEHS-00-11 Low-Income Childhood Care
Page 21 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix I 

Scope and Methodology

This appendix contains detail on our surveys of state child care

administrators, state departments of education, and members of the

National Association of Child Care Resource and Referral Agencies as well

as our case studies in four states.

Survey Methodology We conducted two surveys to obtain information about activities at the

state level. We sent questionnaires to the child care administrators in all 50

states and the District of Columbia to get information about the funds that

states allocate for early childhood programs, the source of the funds, the

characteristics of state-administered child care programs—including the

types of care and services they provided and their availability of

care—difficulties low-income families encounter finding care, how the

states attempt to gauge the adequacy of the supply of care, and factors that

foster or hinder collaboration among early childhood programs. We also

sent questionnaires to the departments of education in each state and the

District of Columbia to get information about state-administered early

education programs. Of the 51 questionnaires we sent to the child care

administrators, 50 were returned—a response rate of 98 percent. Of the 51

questionnaires we sent to state departments of education, 49 were

returned—a response rate of 96 percent.

Because limited information was available on services from most federal

programs, we surveyed resource and referral agencies which have access

to information on various types of care and services provided through

centers and home care providers because of their role in referring

low-income parents to potential child care providers. We used the

membership list of the National Association of Child Care Resource and

Referral Agencies. We sent a questionnaire to each agency listed as a

member of the association, excluding 32 members that we sent to agencies

that were not resource and referral agencies or that were sublocations of

larger resource and referral agencies. The response rate was 80 percent:

428 of the 537 questionnaires we sent were returned.

According to early childhood care and education experts, a survey of the

NACCRRA members was most likely to yield credible local perspectives on

child care programs and an acceptable response rate. However, our survey

should not be considered to be an overall measure of child care services at

the local level. Some resource and referral agencies are not NACCRRA

members, and some child care providers may not be registered with their

local agencies. According to the association, about three-fourths of child

care resource and referral agencies are members.

Page 22 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix I 

Scope and Methodology

Our compilation of programs does not include every program with which a

state addresses early childhood issues. We excluded from our survey

results any reported programs that did not use state or local funds over

and above those required by federal maintenance of effort or matching

requirements. We also excluded funds and any reported programs that did

not serve children directly.

Case Studies We developed in-depth information about early childhood programs,

particularly their collaboration efforts, in Colorado, Ohio, Oregon, and

North Carolina and two localities within each of those states. We chose

states that the National Governors Association and others considered to

have integrated approaches to child care and established frameworks for

state action. We also selected states to get a mix of geographic regions. We

met with states’ officials and also visited at least one primarily urban

jurisdiction and at least one primarily rural jurisdiction. We interviewed

state officials in the education and human services and social services

departments. We talked with state officials responsible for preschool

programs, early childhood education, title I, the Individuals with

Disabilities Education Act, child care subsidies, and child care provider

licensing. We also talked with officials of private and nonprofit

organizations involved in early childhood education or care issues. We

reviewed documentation on these issues. In the two localities we visited in

each state, we interviewed officials responsible for similar programs and

activities at the local level and reviewed documentation about their

programs.

Page 23 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II 

Comments From the Department of Health

and Human Services

Now GAO/HEHS-00-11.

Page 24 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II 

Comments From the Department of Health

and Human Services

Now GAO/HEHS-00-11.

Page 25 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II 

Comments From the Department of Health

and Human Services

Now page 12.

Now page 11.

Page 26 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II 

Comments From the Department of Health

and Human Services

Now page 15.

Page 27 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II 

Comments From the Department of Health

and Human Services

Now page 16.

Page 28 GAO/HEHS-00-11 Low-Income Childhood Care
Appendix III 

GAO Contacts and Staff Acknowledgments

GAO Contacts Harriet Ganson, Assistant Director, (202) 512-9045

Mary Roy, Evaluator-in-Charge, (202) 512-7072

Acknowledgments In addition to the persons named above, Kopp Michelotti, Martha Elbaum,

Margaret Boeckman, and Kelly Mikelson contributed significantly to this

report.

(104930) Page 29 GAO/HEHS-00-11 Low-Income Childhood Care
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