U.S. Department of Health and Human Services

Administration for Children and Families

Office of Planning, Research and Evaluation

Administration on Children, Youth and Families

Head Start Bureau

®

EARLY HEAD STARTEARLY HEAD START

RE SEA R C H

The Role of Early Head Start

Programs in Addressing the

Child Care Needs of LowIncome Families with Infants

and Toddlers: Influences on

Child Care Use and Quality

The Role of Early Head Start Programs in Addressing the Child Care

Needs of Low-Income Families with Infants and Toddlers: 

Influences on Child Care Use and Quality

February 2004

Office of Planning, Research, and Evaluation

Administration for Children and Families

And the Head Start Bureau

Administration on Children, Youth and Families

Department of Health and Human Services
ii 

This report was prepared for the Administration for Children and Families, U.S. Department of 

Health and Human Services (DHHS), under contract HHS-105-95-1936 to Mathematica Policy 

Research, Princeton, NJ. The contents of this report do not necessarily reflect the views or policies 

of DHHS, nor does mention of trade names, commercial products, or organizations imply 

endorsement by the U.S. Government. 

Early Head Start Evaluation Reports 

 

Leading the Way: Describes the characteristics and implementation levels of 17 Early Head Start programs in fall 

1997, soon after they began serving families. 

Executive Summary (December 2000): Summarizes Volumes I, II, and III. 

 Volume I (December 1999): Cross-Site Perspectives—Describes the characteristics of Early Head Start research 

programs in fall 1997, across 17 sites. 

 Volume II (December 1999): Program Profiles—Presents the stories of each of the Early Head Start research 

programs. 

 Volume III (December 2000): Program Implementation—Describes and analyzes the extent to which the programs 

fully implemented, as specified in the Revised Head Start Program Performance Standards, as of fall 1997. 

Pathways to Quality and Full Implementation in Early Head Start (December 2002): Describes and analyzes the 

characteristics, levels of implementation, and levels of quality of the 17 Early Head Start programs in fall 1999, 

three years into serving families. Presents an analysis of the pathways programs followed to achieve full 

implementation and high quality. 

Building Their Futures: How Early Head Start Programs Are Enhancing the Lives of Infants and Toddlers in LowIncome Families: Presents analysis of the impacts that the research programs have had on children’s 

development, parenting, and family development through 2 years of age. 

 Summary Report (January 2001): Synopsis of the major findings. 

 Technical Report (June 2001): Detailed findings and report on methodology and analytic approaches. 

Making a Difference in the Lives of Infants and Toddlers and Their Families: The Impacts of Early Head Start (June 

2002): Presents analysis of the impacts that the research programs have had on children’s development, parenting, 

and family development through the children’s third birthday (including two to three years of program 

participation). 

The Role of Early Head Start Programs in Addressing the Child Care Needs of Low-Income Families with Infants 

and Toddlers: Influences on Child Care Use and Quality (February 2004): Describes the nature, types, and 

quality of child care arrangements in which Early Head Start and control group children enrolled, and presents 

findings on the impacts of Early Head Start on both child care use and quality. 

Health and Disabilities in Early Head Start: Are Families Getting Needed Health Care Services? (December 2003): 

Describes health services received by Early Head Start and control group families, and analyzes services for infants 

and toddlers with disabilities. 
 iii 

Prepared for:

Rachel Chazan Cohen 

Office of Planning, Research and Evaluation 

Administration for Children and Families 

U.S. Department of Health and Human Services 

Washington, DC 

Prepared by:

Mathematica Policy Research, Inc. 

Princeton, NJ 

Under Contract DHHS-105-95-1936 

Authors:

John M. Love 

Jill Constantine 

Diane Paulsell 

Kimberly Boller 

Christine Ross 

Mathematica Policy Research, Inc. 

Helen Raikes 

Society for Research in Child Development Consultant 

Administration for Children and Families 

Christy Brady-Smith 

Jeanne Brooks-Gunn 

Center for Children and Families 

Columbia University Teachers College 

v

ACKNOWLEDGMENTS 

The authors are indebted to many for making this research possible. First and foremost, we 

thank the dedicated directors and staff of the 17 Early Head Start programs who participated in 

the national Early Head Start Research and Evaluation project from 1996 through 2001. Their 

commitment to serving their communities and meeting the needs of their families with infants 

and toddlers inspired us to conduct the rigorous research their programs deserved. We also owe 

incalculable gratitude to the hundreds of anonymous parents and their child care providers who 

allowed us to conduct the interviews and observations that enabled us to address questions of 

crucial policy importance to Early Head Start and related programs. 

The findings reported here are based on research conducted as part of the national Early 

Head Start Research and Evaluation Project funded by the Administration for Children and 

Families (ACF), U.S. Department of Health and Human Services under contract 105-95-1936 to 

Mathematica Policy Research, Princeton, NJ, and Columbia University’s Center for Children and 

Families, Teachers College, in conjunction with the Early Head Start Research Consortium. The 

Consortium consists of representatives from 17 programs participating in the evaluation, 15 local 

research teams, the evaluation contractors, and ACF. Research institutions in the Consortium 

(and principal researchers for conducting this research through 36 months of age) include ACF 

(Rachel Chazan Cohen, Judith Jerald, Esther Kresh, Helen Raikes, and Louisa Tarullo); Catholic 

University of America (Michaela Farber, Harriet Liebow, Nancy Taylor, Elizabeth Timberlake, 

and Shavaun Wall); Columbia University (Lisa Berlin, Christy Brady-Smith, Jeanne BrooksGunn, and Allison Sidle Fuligni); Harvard University (Catherine Ayoub, Barbara Alexander Pan, 

and Catherine Snow); Iowa State University (Dee Draper, Gayle Luze, Susan McBride, Carla 

Peterson); Mathematica Policy Research (Kimberly Boller, Jill Constantine, Ellen Eliason 

Kisker, John M. Love, Diane Paulsell, Christine Ross, Peter Schochet, Susan Sprachman, Cheri 

Vogel, and Welmoet van Kammen); Medical University of South Carolina (Richard Faldowski, 

Gui-Young Hong, and Susan Pickrel); Michigan State University (Hiram Fitzgerald, Tom 

Reischl, and Rachel Schiffman); New York University (Mark Spellmann and Catherine TamisLeMonda); University of Arkansas (Robert Bradley, Richard Clubb, Andrea Hart, Mark 

Swanson, and Leanne Whiteside-Mansell); University of California, Los Angeles (Carollee 

Howes and Claire Hamilton); University of Colorado Health Sciences Center (Robert Emde, Jon 

Korfmacher, JoAnn Robinson, Paul Spicer, and Norman Watt); University of Kansas (Jane 

Atwater, Judith Carta; and Jean Ann Summers); University of Missouri-Columbia (Mark Fine, 

Jean Ispa, and Kathy Thornburg); University of Pittsburgh (Beth Green, Carol McAllister, and 

Robert McCall); University of Washington School of Education (Eduardo Armijo and Joseph 

Stowitschek); University of Washington School of Nursing (Kathryn Barnard and Susan 

Spieker), and Utah State University (Lisa Boyce, Gina Cook, Catherine Callow-Heusser, and 

Lori Roggman). 

We received diligent programming and analysis support from Miriam Loewenberg and 

Xiaofan Sun. Several of our Mathematica colleagues provided insightful comments on earlier 

drafts. We thank Peter Schochet and Ellen Kisker for their careful reviews of earlier drafts. For 

editing and producing the report, we are grateful to Roy Grisham, Jane Nelson, and Bill Garrett. 
vi

We are particularly grateful to Judith Jerald, Early Head Start coordinator in the Head Start 

Bureau, for her guidance, to Michele Plutro, also of the Head Start Bureau, for her careful review 

of an earlier draft, and to the staff of the Child Care Bureau in the Administration on Children, 

Youth and Families (Shannon Christian, Stephanie Currenton, Pia Divine, Ivelisse MartinezBeck, and Karen Tvedt) for their insightful comments on an earlier draft report. Finally, the 

authors wish to thank the Consortium members who reviewed and commented on earlier drafts, 

and in particular members of the Early Head Start Consortium Child Care Working Group. 

Individuals who deserve special thanks include Rachel Chazan Cohen and Louisa Tarullo of 

ACF; Carollee Howes, UCLA; and Susan Spieker, University of Washington. 
vii 

CONTENTS 

Chapter Page 

 EXECUTIVE SUMMARY........................................................................................xvii 

 I CHILD CARE AND EARLY HEAD START: BACKGROUND AND 

PURPOSE OF THE STUDY ......................................................................................... 1 

A. THE CHILD CARE CONTEXT FOR EARLY HEAD START............................ 3 

B. EARLY HEAD START PROGRAM STANDARDS AND CHILD CARE 

OPTIONS................................................................................................................ 5 

C. THE EARLY HEAD START NATIONAL RESEARCH AND 

EVALUATION PROJECT..................................................................................... 9 

D. THE EMBEDDED CHILD CARE STUDY......................................................... 11 

 II PATTERNS OF CHILD CARE USE AND EARLY HEAD START’S 

IMPACTS ON FAMILIES’ CHILD CARE USE....................................................... 13 

A. MEASURING CHILD CARE USE IN THE FIRST THREE YEARS OF 

LIFE ...................................................................................................................... 14 

B. PATTERNS OF CHILD CARE USE BY EARLY HEAD START 

FAMILIES AND CHILDREN.............................................................................. 15 

1. Proportion of All Early Head Start Families Who Used Child Care ............ 15 

2. Characteristics of Early Head Start Families Who Used Child Care............ 19 

3. Types of Primary Child Care Arrangements Used........................................ 21 

4. Intensity of Child Care Service Use.............................................................. 26 

5. Number of Regular Child Care Arrangements Used..................................... 29 

6. Early Head Start Families’ Satisfaction with Child Care Arrangements ...... 29 

7. Summary of Child Care Use Findings .......................................................... 34 

C. IMPACTS OF EARLY HEAD START PROGRAM PARTICIPATION ON 

FAMILIES’ CHILD CARE USE.......................................................................... 37 

1. Approach to Analyzing Impacts on Child Care Use ..................................... 37 

2. Early Head Start Program Impacts on the Percentage of Families Using 

Child Care and on the Amount of Care Used................................................ 38 
CONTENTS (continued) 

Chapter Page

viii

 III. QUALITY OF CHILD CARE USED BY EARLY HEAD START FAMILIES 

AND PROGRAM IMPACTS ON THE QUALITY OF CHILD CARE 

FAMILIES USED ........................................................................................................ 47 

A. MEASURING CHILD CARE QUALITY IN THE EARLY HEAD START 

EVALUATION..................................................................................................... 48 

1. Child Care Settings Included in this Study ................................................... 48 

2. Response Rates.............................................................................................. 49 

3. Procedures and Instruments Used ................................................................. 51 

B. QUALITY OF CHILD CARE USED BY EARLY HEAD START 

FAMILIES ............................................................................................................ 54 

1. Quality of Child Care Used (Global Measures) ............................................ 54 

2. Quality of Child-Caregiver Interactions (as Measured by the C-COS) ........ 62 

3. Quality Experienced by Early Head Start Children in Early Head Start 

and Community Centers................................................................................ 67 

C. SUMMARY OF EARLY HEAD START QUALITY OF CHILD CARE .......... 75 

D. EARLY HEAD START PROGRAMS’ IMPACTS ON CHILD CARE 

QUALITY ............................................................................................................. 76 

1. Approach to the Analyses of Impacts on Child Care Quality....................... 77 

2. Early Head Start’s Impact on the Percentage of Families in GoodQuality Center Child Care—Global Measures.............................................. 80 

3. Early Head Start’s Impact on the Percentage of Families in GoodQuality Center Child Care—Child-Caregiver Interactions (C-COS 

Scores)........................................................................................................... 85 

4. Summary of Program Impacts on Percentages of Children Receiving 

Good-Quality Center Child Care................................................................... 88 

5. Differences in the Average Quality of Care for Children Observed in 

Care ............................................................................................................... 88 

6. Summary of Program-Control Differences in Quality of Center Care 

Received ........................................................................................................ 93 

E. RELATIONSHIPS BETWEEN CHILD CARE QUALITY AND 

INTENSITY AND CHILD OUTCOMES AMONG EARLY HEAD START 

CHILDREN........................................................................................................... 96 
CONTENTS (continued) 

Chapter Page

ix

 IV SUMMARY AND CONCLUSIONS........................................................................... 99 

REFERENCES........................................................................................................... 105 

APPENDIX A: SUPPLEMENTARY TABLES ....................................................... A.1 

APPENDIX B: PROCEDURES FOR TRAINING AND ESTABLISHING 

RELIABILITY ON THE CLASSROOM OBSERVATION 

QUALITY MEASURES...................................................................B.1 

xi 

TABLES 

Table Page 

 II.1 PERCENTAGE OF PROGRAM FAMILIES IN CHILD CARE AT 14, 24, 

AND 36 MONTHS BY FAMILY CHARACTERISTICS ................................... 20 

 III.1 RESPONSE RATES TO THE CHILD CARE OBSERVATIONS...................... 50 

 III.2 AVERAGE CLASSROOM QUALITY SCORES FOR CENTER CARE 

USED BY EARLY HEAD START FAMILIES (ALL SITES, WHEN 

CHILD WAS 14, 24, AND 36 MONTHS OLD).................................................. 56 

 III.3 AVERAGE QUALITY SCORES FOR FAMILY CHILD CARE USED BY 

EARLY HEAD START FAMILIES (ALL SITES, WHEN CHILD WAS 

14, 24, AND 36 MONTHS OLD)......................................................................... 61 

 III.4 AVERAGE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) 

SCORES FOR CENTER AND FAMILY CHILD CARE SETTINGS 

USED BY EARLY HEAD START FAMILIES WHEN CHILDREN 

WERE 24 AND 36 MONTHS OLD..................................................................... 65 

 III.5 AVERAGE QUALITY SCORES OF CHILD CARE CENTERS USED BY 

EARLY HEAD START AND CONTROL CHILDREN AT CENTERBASED SITES ...................................................................................................... 91 

 III.6 AVERAGE QUALITY SCORES OF CHILD CARE CENTERS USED BY 

EARLY HEAD START AND CONTROL CHILDREN AT MIXEDAPPROACH SITES .............................................................................................. 92 

 III.7 AVERAGE NUMBER OF INCIDENTS OF CAREGIVER AND CHILD 

BEHAVIORS CODED BY THE CHILD-CAREGIVER OBSERVATION 

SYSTEM (C-COS) IN CHILD CARE CENTERS AT CENTER-BASED 

SITES .................................................................................................................... 94 

 III.8 AVERAGE NUMBER OF INCIDENTS OF CAREGIVER AND CHILD 

BEHAVIORS CODED BY THE CHILD-CAREGIVER OBSERVATION 

SYSTEM (C-COS) IN CHILD CARE CENTERS AT SELECTED 

MIXED-APPROACH SITES................................................................................ 95 

xiii 

FIGURES 

Figure Page 

 II.1 USE OF CHILD CARE BY EARLY HEAD START CHILDREN AT 14, 

24, AND 36 MONTHS OF AGE .......................................................................... 18 

 II.2 PRIMARY CHILD CARE ARRANGEMENTS OF EARLY HEAD 

START CHILDREN AT 14, 24, AND 36 MONTHS OF AGE........................... 22 

 II.3 PRIMARY CHILD CARE ARRANGEMENTS FOR EARLY HEAD 

START CHILDREN AT 36 MONTHS OF AGE, BY PROGRAM 

APPROACH.......................................................................................................... 24 

 II.4 PERCENTAGE OF EARLY HEAD START CHILDREN WHO 

RECEIVED THEIR PRIMARY CHILD CARE DURING 

NONSTANDARD HOURS, AT 24 MONTHS OF AGE, BY PROGRAM 

APPROACH.......................................................................................................... 25 

 II.5 AVERAGE HOURS PER WEEK IN CHILD CARE FOR EARLY HEAD 

START CHILDREN AT 14, 24, AND 36 MONTHS OF AGE........................... 27 

 II.6 PERCENTAGE OF EARLY HEAD START CHILDREN IN CHILD 

CARE FOR AT LEAST 30 HOURS PER WEEK AT 14, 24, AND 36 

MONTHS OF AGE, BY PROGRAM APPROACH ............................................ 28 

 II.7 PERCENTAGE OF EARLY HEAD START CHILDREN IN CENTER 

CHILD CARE FOR AT LEAST 30 HOURS PER WEEK AT 14, 24, AND 

36 MONTHS OF AGE, BY PROGRAM APPROACH ....................................... 30 

 II.8 SATISFACTION WITH PRIMARY CHILD CARE ARRANGEMENTS 

28 MONTHS AFTER ENROLLMENT ............................................................... 32 

 II.9 TYPES OF CHILD CARE ARRANGEMENTS PREFERRED BY EARLY 

HEAD START FAMILIES WHO WANTED TO CHANGE 

ARRANGEMENTS .............................................................................................. 35 

 II.10 MAIN REASONS FAMILIES WOULD WANT TO CHANGE CHILD 

CARE ARRANGEMENTS, BY TYPE OF CARE PREFERRED, 28 

MONTHS AFTER ENROLLMENT .................................................................... 36 

 II.11 IMPACTS ON CHILD CARE USE AT 14, 24, AND 36 MONTHS OF 

AGE....................................................................................................................... 39 

 II.12 IMPACTS ON USE OF CENTER CHILD CARE AT 14, 24, AND 36 

MONTHS OF AGE............................................................................................... 40 
FIGURES (continued)

Figure Page

xiv

 II.13 IMPACTS ON AVERAGE HOURS PER WEEK IN ANY CHILD CARE 

AT 14, 24, AND 36 MONTHS OF AGE.............................................................. 42 

 II.14 IMPACTS ON AVERAGE HOURS PER WEEK IN CENTER CHILD 

CARE AT 14, 24, AND 36 MONTHS OF AGE .................................................. 43 

 II.15 IMPACTS ON USE OF CARE DURING NONSTANDARD HOURS IN 

PRIMARY CHILD CARE ARRANGEMENTS AT 24 MONTHS OF AGE ..... 44 

 III.1 AVERAGE ITERS SUBSCALE SCORES FOR CENTER CARE USED 

BY EARLY HEAD START FAMILIES (ALL SITES, WHEN CHILDREN 

WERE 14 AND 24 MONTHS OLD).................................................................... 58 

 III.2 AVERAGE ECERS-R SUBSCALE SCORES FOR CENTER CARE USED 

BY EARLY HEAD START FAMILIES (ALL SITES, WHEN CHILD 

WAS 36 MONTHS OLD)..................................................................................... 59 

 III.3 AVERAGE FDCRS SUBSCALE SCORES FOR FAMILY CHILD CARE 

USED BY EARLY HEAD START FAMILIES (ALL SITES, WHEN 

CHILDREN WERE 14, 24, AND 36 MONTHS OLD) ....................................... 63 

 III.4 AVERAGE ITERS AND ECERS-R QUALITY RATINGS FOR EARLY 

HEAD START AND COMMUNITY CENTERS WHEN CHILDREN 

WERE 14, 24, AND 36 MONTHS OLD.............................................................. 68 

 III.5 AVERAGE ITERS AND ECERS-R SUBSCALE SCORES FOR EARLY 

HEAD START AND COMMUNITY CENTERS (ALL SITES, WHEN 

CHILDREN WERE 14, 24, AND 36 MONTHS OLD) ....................................... 70 

 III.6 AVERAGE CAREGIVER ARNETT SCORES FOR EARLY HEAD 

START AND COMMUNITY CENTERS WHEN CHILDREN WERE 14, 

24, AND 36 MONTHS OLD ................................................................................ 72 

 III.7 AVERAGE CHILD-ADULT RATIOS FOR EARLY HEAD START AND 

COMMUNITY CENTERS WHEN CHILDREN WERE 14, 24, AND 36 

MONTHS OLD..................................................................................................... 73 

 III.8 AVERAGE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) 

SCORES FOR EARLY HEAD START AND COMMUNITY CENTERS 

WHEN CHILDREN WERE 24 AND 36 MONTHS OLD................................... 74 

 III.9 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

IN GOOD-QUALITY, CENTER CARE, WHEN THEY WERE 14, 24, 

AND 36 MONTHS OLD ...................................................................................... 81 
FIGURES (continued)

Figure Page

xv

 III.10 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

IN GOOD-QUALITY, CENTER CARE, AT CENTER-BASED SITES 

WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD............................ 82 

 III.11 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

IN GOOD-QUALITY, CENTER CARE, AT SELECTED MIXEDAPPROACH SITES WHEN CHILDREN WERE 14, 24, AND 36 

MONTHS OLD..................................................................................................... 83 

 III.12 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

IN CENTER CARE THAT MEETS THE HEAD START PROGRAM 

PERFORMANCE STANDARDS FOR CHILD-ADULT RATIOS, AT 

CENTER-BASED SITES WHEN CHILDREN WERE 14, 24, AND 36 

MONTHS OLD..................................................................................................... 84 

 III.13 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

IN CENTER CARE THAT MEETS THE HEAD START PROGRAM 

PERFORMANCE STANDARDS FOR CHILD-ADULT RATIOS, AT 

SELECTED MIXED-APPROACH SITES WHEN CHILDREN WERE 14, 

24, AND 36 MONTHS OLD ................................................................................ 86 

 III.14 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

EXPERIENCING HIGH LEVELS OF CAREGIVER TALK IN CENTER 

CARE AT CENTER-BASED SITES WHEN CHILDREN WERE 24 AND 

36 MONTHS OLD................................................................................................ 87 

 III.15 IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN 

EXPERIENCING HIGH LEVELS OF CAREGIVER TALK IN CENTER 

CARE AT MIXED-APPROACH SITES WHEN CHILDREN WERE 24 

AND 36 MONTHS OLD ...................................................................................... 89 

xvii 

EXECUTIVE SUMMARY 

In 1994, the Secretary’s Advisory Committee on Services for Families with Infants and 

Toddlers set forth a vision for Early Head Start programs in declaring that all child care settings 

used by Early Head Start families, whether or not the program provides the care directly, must 

meet the high standards of quality embodied in the Head Start Program Performance Standards. 

As part of the national Early Head Start Research and Evaluation project, we collected extensive 

data on the child care settings used by Early Head Start and control group families for their 

children at three ages (14, 24, and 36 months). This report describes the patterns of child care 

use by Early Head Start families and the impacts that program participation had on families’ 

child care use and the quality of care used. 

Child Care Use by Early Head Start Families 

A high proportion of Early Head Start families placed their children in child care during the 

evaluation period, with higher levels of child care use among those in center-based sites: overall, 

nearly two-thirds of 3-year-old Early Head Start children spent at least 30 hours per week in 

some kind of child care arrangement. Child care use increased slightly as children got older, 

going from an average of 29 hours a week around the time the Early Head Start children were 

14 months old to 32 hours when they were 36 months. Almost half (48 percent) of 3-year-old 

children were in centers as their primary arrangement; 35 percent were in informal relative or 

nonrelative care. 

Child Care Quality Experienced by Children in Early Head Start 

Early Head Start children attending classrooms in Early Head Start centers consistently 

experienced good-quality care across the three ages (quality ratings averaged between 5.0 and 

5.2 on the ITERS and ECERS-R). The quality of community centers Early Head Start children 

attended was somewhat lower, but improved over time, from a mean of 3.8 on the ITERS at 

14 months to 4.9 on the ECERS-R at 36 months. Overall, at age 3, Early Head Start children in 

center care, whether operated by Early Head Start programs or not, experienced good quality, 

averaging 5.0 on the ECERS-R. Child-adult ratios in Early Head Start centers consistently met 

the Head Start Program Performance Standards. Furthermore, child-adult ratios in Early Head 

Start centers were consistently lower (fewer children per adult) than the ratios children 

experienced when they were in community centers. The report includes findings pertaining to 

family child care, but because we were not as successful in gaining access to these settings, we 

are less confident about characterizing the quality of informal child care. 

Using a measure of caregiver-child interactions developed for this evaluation (the ChildCaregiver Observation System, C-COS), we found that in about half the observation periods 

coded, Early Head Start caregivers were observed talking with the focus child; the frequency of 

caregiver talk was greater in Early Head Start than in community centers when children were 

3 years old (but not when they were 2). Early Head Start caregivers also initiated talk with the 

child more than caregivers in community centers did, but only at age 3. Incidents of negative 
xviii 

child behavior were very low for all Early Head Start children, and were not different in Early 

Head Start and community centers at either age. 

Very high percentages of Early Head Start parents reported being satisfied with their recent 

primary child care arrangement—they liked how much attention the child received, how much he 

or she was learning, its safety features, and how “good” they thought the provider was with 

children. Nevertheless, 29 percent of parents said they would like to change the arrangement, if 

cost were not a factor (at 28 months after enrolling in Early Head Start). This was true of parents 

with children in community centers, as well as to those in Early Head Start centers. The longer 

families were enrolled in Early Head Start (and the older their children were), the more likely 

they were to be using a child care arrangement they liked. 

When parents expressed an interest in changing arrangements, they overwhelmingly 

preferred center care (80 percent of parents at 28 months after enrollment); small percentages 

preferred relative care or other arrangements. When parents wanted to switch to center care, 

they typically wanted their child to learn better and to be with other children. When parents 

wanted to change to relative care, it was mainly for convenience and to ensure the child’s safety. 

Impacts of Program Participation on Child Care Use and Quality 

In impact analyses comparing child care use by program and control group families across 

all 17 sites in the research sample, we found that at all ages Early Head Start programs 

significantly increased the percentage of families using any child care, the percentage using 

center care, and the average hours per week that children were in care. Program participation 

also led to a smaller percentage of parents with primary care arrangements during nonstandard 

hours (both evening and weekend hours). 

Early Head Start programs dramatically increased the percentage of children who were in 

good-quality center care at all ages at the four center-based sites and selected mixed-approach 

sites. Early Head Start children were 3 times more likely to be in good-quality center care than 

were control group children at 14 and 24 months of age, and about 11⁄2 times more likely to be in 

good-quality centers at 36 months. The impacts were somewhat larger in center-based than in 

the Early Head Start mixed-approach sites. 

It is likely that participation in the Early Head Start program was responsible for the 

program-control differences in center quality that we observed in sites where a sufficient sample 

of quality observations was available. Children in Early Head Start centers experienced 

significantly higher quality than did control group children in the same sites—on the ITERS at 

14 and 24 months of age and on the ECERS-R at 36 months, on the Arnett scale at all three ages, 

and on child-adult ratios at all ages. Program children experienced classrooms with ITERS 

scores about 1 point higher than those experienced by control group children at 14 and 

24 months of age. The program-control difference in ratio was more than 1 adult per child. 

Finally, regression analyses within the Early Head Start sample demonstrated that amount 

and quality of center care are associated with positive developmental outcomes for the children, 

a finding that is consistent with an extensive child care research literature. 
xix 

Conclusion 

These results demonstrate the highly important role Early Head Start programs have played 

in responding to the vision of the Advisory Committee on Services for Families with Infants and 

Toddlers. Early Head Start families were not only receiving more child care but substantially 

more good-quality center child care than they would have received without the intervention of 

the Early Head Start programs. Along critical dimensions, the quality of Early Head Start center 

child care was higher than the quality control group children experienced, and evidence suggests 

that this quality is important for enhancing the children’s development. 

1

I. CHILD CARE AND EARLY HEAD START: BACKGROUND AND 

PURPOSE OF THE STUDY 

Child care is one of many services Early Head Start programs provide to families. 

Furthermore, the Early Head Start national evaluation found that the vast majority of Early Head 

Start families used child care at some point during the child’s first three years of life, and many 

of these families called on their Early Head Start programs to help provide or find affordable, 

good-quality child care. Because of the centrality of child care to many Early Head Start 

programs, the pervasive importance of child care for low-income families with infants and 

toddlers, and the challenges programs faced in developing child care options that could meet 

Head Start Program Performance Standards, the Administration for Children and Families 

commissioned this special Early Head Start policy report using data from the national evaluation. 

In this report, we examine patterns of child care use among Early Head Start families at 

points corresponding to children’s first, second, and third birthdays and then describe how Early 

Head Start influenced those patterns of child care use. We also examine the quality of child care 

used by Early Head Start children at these three birth dates. Third, since Early Head Start 

programs are charged with ensuring that children receive good-quality child care, we take 

advantage of the randomized design of the Early Head Start evaluation to examine the impact 

that Early Head Start had on the quality of child care experienced at all three ages, using data 

from the four center-based sites included in the evaluation and a subset of the mixed-approach 

sites, where we obtained a substantial and representative sample of observations of child care 

used by both program and control group children. Finally, we conducted analyses within the 

Early Head Start sample to examine relationships between child care use and quality and selected 

child outcomes at ages 2 and 3. 
2

Thus, our research questions include, first, descriptive questions about the child care 

services used by Early Head Start families: 

• What types of child care were used by families in Early Head Start and for what 

hours? 

• What was the quality of child care used by Early Head Start families? 

• How satisfied were Early Head Start families with their child care arrangements? 

The research also includes questions about the impacts of Early Head Start on child care use: 

• How did Early Head Start affect families’ child care use, including the type and hours 

of child care? 

• How did Early Head Start affect the quality of child care used? 

Finally, we ask a question about relationships between child care and children’s 

development to provide evidence relating to an important issue, albeit using an analytic approach 

that is not as strong as those that address the more-central research questions: 

• How, and to what extent, were the child care intensity and quality experienced by 

Early Head Start children associated with developmental outcomes at 2 and 3 years of 

age? 

In this chapter we begin by providing the context—how the vision of the initial blueprint for 

Early Head Start brought together the twin themes of quality and partnership. We then describe 

the Early Head Start programs and how they worked to develop child care options in their 

communities. Finally, we discuss the design of the Early Head Start evaluation and the study of 

child care embedded in that evaluation. 
3

A. THE CHILD CARE CONTEXT FOR EARLY HEAD START 

Many communities struggle to help working parents find stable, supportive child care for 

their infants and toddlers (Paulsell, Nogales, and Cohen 2003). Providing good-quality infanttoddler care poses stiffer challenges than care for preschool-age children, primarily because 

younger children need more attention from adults to meet health, safety, and developmental 

needs, and the corresponding need for lower child-adult ratios increases the costs of infanttoddler care. 

As early as 1994, when the Early Head Start program was authorized, the lack of goodquality infant-toddler care for low-income families was a public concern, and indeed, was one of 

the issues that planners sought to address through the design of the program. In that year, the 

Carnegie Corporation released its Starting Points report citing major risk factors confronting a 

significant number of children under 3 years of age. One of the risks cited was substandard child 

care.1

In light of these concerns about the quality of infant-toddler child care, the Secretary’s 

Advisory Committee on Services for Families with Infants and Toddlers, in its blueprint for the 

Early Head Start program, underscored the importance of several key themes that were integral 

to its vision for the new program and for the role that child care services would play (U.S. 

Department of Health and Human Services 1994). These themes included: 

• The expectation that Early Head Start would offer high-quality services—whether 

provided directly by program staff or through partnerships with other community 

services providers 

 1

Other risk factors cited by the report were increased chances of living with a single and 

younger parent; family poverty; increases in foster care; high mortality rates and low rates of 

immunization; and physical abuse, neglect, and unintentional injury (Carnegie Corporation of 

New York 1994). 
4

• The importance to children’s healthy development of establishing secure, continuous 

relationships between young children and their caregivers 

• The necessity of establishing strong partnerships with parents and community 

partners 

• A mandate to undertake community-building efforts that would increase the level of 

community support for families with infants and toddlers. 

The expectation that Early Head Start programs would form partnerships with communitybased organizations and engage in community-building efforts has led naturally to partnerships 

between Early Head Start and the child care community, given the critical importance of child 

care services to low-income families with infants and toddlers. The rapid proliferation of 

welfare reform programs across the states in the early 1990s only intensified the need for infanttoddler child care because work requirements were, for the first time, being applied to mothers 

with children under 3 years.2

 The Committee reinforced the importance of partnerships with 

child care by declaring that, “child care can be provided directly or in collaboration with other 

community providers as long as the Early Head Start program assumes responsibility for 

ensuring that all settings meet the Early Head Start performance standards” (U.S. Department 

of Health and Human Services 1994, p. 16; emphasis added). 

Child care subsidy programs funded jointly by federal and state governments and the 

funding initiatives of community and private organizations have also sought to address the need 

for infant-toddler care. In some cases, these programs have contributed to partnerships with 

Early Head Start through which good-quality infant-toddler care has developed (Mitchell, 

Stoney, and Dichter 1997; and Paulsell et al. 2003). At the time Early Head Start was being 

implemented, federal welfare reform legislation combined several child care funding streams 

 2

State welfare reform programs were adopted under waivers of federal rules for the Aid to 

Families with Dependent Children (AFDC) program during the early 1990s. 
5

into a single Child Care and Development Fund. CCDF provides funds to states and territories 

and tribes to assist low-income families in paying for child care, and reserves some funds for 

investment in quality improvement activities, technical assistance, and research. Federal funding 

for state child care subsidy programs increased and resources expanded further as states 

transferred substantial TANF resources to CCDF (Collins, Layzer, Kreader, Werner, and Glantz 

2000; and Schumacher, Greenberg, and Duffy 2001). In addition, CCDF includes a $100 million 

earmark for infant-toddler child care supply and quality enhancement activities ($22 million in 

fiscal year [FY] 2001), which some states have used to support infant-toddler provider training 

and for grants linked to improvements in the quality or supply of infant/toddler child care 

(Administration for Children and Families 2002a). 

B. EARLY HEAD START PROGRAM STANDARDS AND CHILD CARE OPTIONS 

Early Head Start grantees are required to provide child development services, build family 

and community partnerships, and support the staff needed to provide high-quality services for 

children and families. Grantees select among program options specified in the performance 

standards to fulfill these goals. The program options include: 

• Home-based—provide Early Head Start program services to children primarily in the 

child’s home, through weekly home visits and at least two group socializations per 

month for each family 

• Center-based—provide services to children primarily through center-based child care 

plus other activities, and offer a minimum of two home visits per year for each family 

• Combination option—provide services to children in both a child care center and in 

the child’s home; includes a prescribed combined number of home visits and centerbased experiences 

In addition, grantees can propose alternative program variations to meet community needs, 

subject to approval by the Administration on Children, Youth and Families (ACYF) in the 
6

Administration for Children and Families (ACF) in the U.S. Department of Health and Human 

Services (DHHS). Grantees may, with regional office approval, change their program options in 

response to emerging needs of families. For example, a home-based program may become a 

combination option in response to a growing need for child care and the opportunity to partner 

with a community child care provider who can offer care meeting the Head Start performance 

standards. Early Head Start evaluation reports adopted the convention of referring to programs 

as “mixed approach” when they offered both center- and home-based services, regardless of their 

official program “option.” 

• Mixed approach—provide services to some children primarily in the home, through 

weekly home visits and periodic group socializations; and to some children primarily 

through center-based care or family child care with periodic visits to the home and/or 

child care setting. Children may receive home-based services at one point and centerbased services at another as they progress through the program. 

Standards for the quality of Early Head Start child care services were formalized in January 

1998, when the revised (and current) Head Start Program Performance Standards took effect. 

The standards established a clear set of expectations for the quality of both center-based child 

development services and child care provided in community child care settings.3

 Among other 

things, the standards require (1) a child-staff ratio of 4 to 1 and a maximum group size of eight 

infants and toddlers in center-based child care settings, and (2) child care staff to have a Child 

Development Associate (CDA) credential within one year of being hired as an infant-toddler 

teacher (U.S. Department of Health and Human Services 1996). 

 3

In August 2000, the DHHS issued draft performance standards for services provided 

through family child care homes (U.S. Department of Health and Human Services 2000). Under 

these standards, teachers in family child care homes must possess the same qualifications as 

center-based teachers. Ratio and group-size requirements limit groups to six children per teacher 

when two or fewer children are under age 3. If more than two children are under age 3, the 

maximum group size is four children, with no more than two children under age 2. 
7

In keeping with the Committee’s recommendation, the Head Start Bureau expects programs 

to help all families find and access child care arrangements if and when they need child care. 

Moreover, programs must make significant efforts to ensure that these arrangements, whether 

provided in a child care center operated by Early Head Start or through a community child care 

provider, adhere to the Head Start Program Performance Standards. Grantees are charged with 

developing systems to support and monitor this effort. The evaluation’s implementation reports 

(Leading the Way and Pathways to Quality) have documented the challenges programs faced in 

meeting the child development aspects of the performance standards (ACYF 1999, 2000; and 

ACF 2002c). Over time, most of the programs reached compliance with these standards 

(ACF 2002c). 

The growing importance of child care services for low-income parents with infants and 

toddlers has thus enhanced the salience of child care issues for Early Head Start grantees. At the 

same time, community child care providers have found an important source of support in Early 

Head Start. Across many communities, Early Head Start and child care are intertwined in a 

variety of ways, many of which respond to the vision of the Advisory Committee on Services for 

Families with Infants and Toddlers (U.S. DHHS 1994):4

• Some Community Child Care Providers Became Early Head Start Grantees. 

Community-based child care providers who operate good-quality programs are 

typically skilled at obtaining available funding to support their mission. Some Early 

Head Start grantees originated as community-based child care providers that offered 

good-quality infant-toddler child care before 1995, and they secured competitive 

Early Head Start grants to support extending their mission, for example, by adding 

more infant-toddler slots or by expanding comprehensive services for families 

(ACF 2002c). 

 

4

The various strategies programs used to improve the quality of child care for infants and 

toddlers, and their collaboration with other community-based organizations toward this goal, are 

described in more detail in Pathways to Quality (ACF 2002c). 
8

• Some Early Head Start Grantees Created New Infant/Toddler Classrooms. Some 

Early Head Start grantees began as Head Start programs and extended their mission 

by adding services for infants and toddlers, sometimes by opening infant/toddler 

classrooms in the Head Start center (ACF 2002c). Some grantees started out as 

family support agencies (for example, former Comprehensive Child Development 

Programs, or CCDPs). Many of these agencies recognized the need for good-quality 

infant-toddler care when parents enrolled in their programs seeking child care and 

when the Head Start Bureau highlighted the child development aspects of the 

performance standards. Some responded to the need by establishing infant-toddler 

classrooms. These classrooms could be on site at the Early Head Start program or 

developed through partnership with an established child care center in the community 

that could find space for another classroom. 

• Some Early Head Start Grantees Contracted with Community Child Care Providers 

for Child Care Services. Some grantees contracted for a specified number of slots in 

community-based child care centers or family child care homes. The Early Head 

Start grantee would work with these providers to ensure that performance standards 

were met (including ratio and training requirements). The Early Head Start funding 

sometimes enabled a center to keep open an infant-toddler room that included both 

Early Head Start and other children (Paulsell, Nogales, and Cohen 2003). 

• Some Early Head Start Grantees Extended Quality Enhancement Assistance to 

Community Child Care Providers. Grantees also worked on quality improvement 

with the child care providers whom parents chose on their own. Grantees offered 

training and technical assistance to help with planning activities, arranging the room, 

communicating with parents, and running a business. Some providers received 

equipment (such as cribs, shelving, and outdoor play equipment), and opportunities to 

network with other providers. One program developed individual quality 

enhancement plans with providers and offered incentives, materials, and training to 

encourage and enable providers to make progress toward their goals (ACF 2002c). 

• Some Early Head Start Grantees Reached Out to Family, Friends, and Neighbors 

Caring for Early Head Start Children. Early Head Start grantees implemented 

creative strategies for developing relationships to support quality enhancement among 

family, friend, and neighbor providers parents had selected. Several programs began 

making monthly home visits to children in these child care settings to foster a 

partnership between the provider and Early Head Start, to share child development 

information with the provider, and to work with the provider on quality improvement 

(ACF 2002c). 

As the examples indicate, Early Head Start grantees and community child care providers 

work together in many ways to expand the supply of good-quality infant/toddler care. The 

variety of responses to families’ child care needs exemplify the ways in which Early Head Start 
9

grantees tailor their services to reflect the needs of low-income, pregnant women and families 

with infants and toddlers in their communities. 

C. THE EARLY HEAD START NATIONAL RESEARCH AND EVALUATION 

PROJECT 

This policy report is based on analyses conducted as part of the Early Head Start National 

Research and Evaluation Project, a rigorous, large-scale, random-assignment evaluation of 

17 Early Head Start programs (see the study’s final report—ACF 2002b). The research 

programs, selected purposively from the first two waves of programs funded in 1995 and 1996, 

are located in all regions of the country and in both urban and rural settings. The research 

sample of families reflects the diverse family characteristics and the major program approaches 

of all programs funded in 1995 and 1996. 

To be eligible for Early Head Start, families must include a pregnant woman or a child under 

3 years old, and for the most part, families must have income at or below the federal poverty 

guidelines ($15,600 for a family of four in FY1996 when the research sample began enrolling; 

$16,050 in FY1997). In addition, grantees are required to make at least 10 percent of their 

spaces available to children with disabilities who are eligible for Part C services under the 

Individuals with Disabilities Education Act in their state. Grantees may develop additional 

eligibility criteria to help target services to best meet the needs in their communities. Important 

for this study, families eligible for the Early Head Start research sample had to include a 

pregnant caregiver or a child younger than 12 months of age. 

Once programs determined through their application process that families met the Early 

Head Start and the research eligibility guidelines, Mathematica Policy Research (MPR) 

randomly assigned the families either to the program or to the control group (with equal 

probabilities). Program staff then contacted the program group families, while representatives of 
10

the local research partners notified the control group families of their status. Families were 

enrolled in the research sample from July 1996 through September 1998. A total of 3,001 

families were randomly assigned, with 1,513 in the program group and 1,488 in the control 

group. The samples in most sites included between 150 and 200 families, divided fairly evenly 

between the two research groups. 

Control group families were able to receive any services in the community except Early 

Head Start until their applicant child reached the age of 3 (and was no longer eligible for Early 

Head Start). Many control group families received parenting education and child care services 

without the assistance of Early Head Start. Comparing outcomes for groups that differ only in 

the offer of Early Head Start services ensured that our analytic comparisons of program and 

control group outcomes represented the effects of Early Head Start services relative to the receipt 

of all other community services that would be available to families in the absence of Early Head 

Start. Analyses of the research sample indicated that random assignment was implemented well. 

The random assignment process yielded equivalent groups (in terms of average baseline 

characteristics). For the most part, control-group families did not receive any Early Head Start 

services. Details about the random assignment process and its integrity are documented in the 

evaluation’s final report (ACF 2002b). 

The major focus of the evaluation were the impacts of Early Head Start on family wellbeing, the parent-child relationship, and children’s development, which have been reported in the 

evaluation’s interim (results through age 2; ACYF 2001) and final (through age 3; ACF 2002b) 

reports, and summarized in the child development literature (Love et al. 2003; and Raikes et al. 

in press). 

To measure these impacts, the evaluation included parent surveys at specified intervals after 

random assignment (7, 16, and 28 months) and parent interviews coupled with child assessments 
11

and observations of parent-child interactions at intervals linked to the child’s age. These parallel 

data collection efforts included the following information: 

• Parent Services Interviews—at 7, 16, and 28 months after random assignment, 

measured the parent’s employment and education activities, maternal and child 

health, and use of a broad set of services that Early Head Start programs might 

provide, but which families might also obtain on their own in the community. The 

Parent Services Interviews were designed to capture monthly information on 

employment and service use so that durations and changes in these activities could be 

examined. An exit interview conducted at the time of the 36-month birthday-related 

assessment provides a snapshot of the parent’s economic activity and key services 

used at the time children were transitioning out of Early Head Start.5

• Birthday-Related Assessments—conducted when children were 14, 24, and 

36 months old, were designed to gauge children’s development across cognitive, 

language, and social-emotional domains when they were infants, toddlers, and 

beginning preschoolers. Parenting knowledge, the home environment, and qualities 

of the parent-child relationship were also measured at the birthday-related 

assessments because these aspects of parenting and the child’s environment relate 

closely to children’s development. 

For many types of analysis, the two streams of data can be used independently to provide, 

for example, a record of service use following random assignment, or measures of child 

development and parenting at the three age points. But some analyses require combining these 

data sets. The study of child care embedded in the broader Early Head Start evaluation includes 

elements of service use (the types and characteristics of child care arrangements used over time) 

and elements of the child’s environment (the quality of child care). 

D. THE EMBEDDED CHILD CARE STUDY 

The dual nature of child care, as both a service to parents that supports employment and 

education activities and an environment in which children grow and develop, led us to measure 

aspects of child care through both data collection streams. The Parent Services Interviews 

 5

Families did not have an exit interview if their 28-month Parent Services Interview 

occurred when the child was age 30 months or older. 
12

measured child care use over time so that the data could easily be related to patterns of 

employment and education activities. The birthday-related assessments included interviews with 

providers and observational assessments of the child care environments so that the information 

could easily be related to assessments of the home environment, parenting, parent-child 

interactions, and children’s development obtained at the same time. 

• Parent Services Interviews. Parents were asked about the types of child care used, 

hours, cost to the family, and satisfaction with care since random assignment. From 

this information, variables measuring the type, duration, and stability of child care 

could be calculated for a specific point in time or over a period of time. 

• Birthday-Related Assessments. Parents were asked about the types of care used at 

the time of each birthday-related assessment, thus providing a snapshot of the child 

care arrangements used at the time of the child assessments. For children with a 

regular, out-of-home child care arrangement, we conducted in-depth, observational 

assessments of the quality of child care used by children. From this information, 

global ratings of the quality of the primary child care arrangement were obtained, as 

well as ratings of provider behavior, snapshots of the child’s experiences in child 

care, staff-child ratios, group size, provider education and training, and other provider 

characteristics. 

Using these data, we conducted analyses designed to answer the questions raised at the 

beginning of this chapter. Our findings are reported in two chapters. Chapter II focuses on child 

care use and parents’ satisfaction with their child care arrangements. We examine the patterns of 

child care use (types of arrangements) and intensity of use (amount of time in care) among Early 

Head Start children and then compare Early Head Start and control-group children’s child care 

participation to assess the impact that the program had. In Chapter III, we focus on quality, 

reporting both the nature and range of quality of care experience by Early Head Start children 

and the impacts the program had on the quality of children’s child care placements. We also 

explore the relationships among intensity and quality, on the one hand, and children’s 

developmental outcomes, on the other. Each chapter includes descriptions of the instruments 

used to collect the usage and quality data and the analytic methods employed. 
13

II. PATTERNS OF CHILD CARE USE AND EARLY HEAD START’S IMPACTS 

ON FAMILIES’ CHILD CARE USE 

The child care available to children through participation in the Early Head Start program 

varied by program approach (for an in-depth discussion, see Pathways to Quality, ACF 2002c). 

All four center-based programs provided Early Head Start services through center care, typically 

for 6 hours or more per day. Parents needing child care at other hours could often extend the 

child’s time at the center to meet this need. Of the 11 Early Head Start programs that we 

considered as offering a mixed approach in 1999, six programs offered on-site child care to some 

children in the program, and contracted with, or referred families to, child care providers in their 

communities for good-quality center child care. Home-based programs also found a variety of 

ways to connect families with the child care they needed. For example, one undertook a 

community initiative to improve the quality of community child care used by its families, and 

another began providing respite care in a small on-site center. When families used child care 

settings that were not directly provided by Early Head Start programs, the community child care 

was sometimes arranged for by the program, while in other instances families found care on their 

own. 

Thus, across all programs, Early Head Start children could be found in the full range of child 

care settings, including center care (some meeting Head Start performance standards and some 

not), family child care (regulated and not regulated), and in-home care (with relatives or 

nonrelatives). All these categories of arrangements are included in the analyses of child care use 

and quality reported here.1

 1

In this report, we refer to all in-home child care settings as “family child care,” whether 

care was provided by a relative or nonrelative caregiver. Because the regulation of care provided 
14

This chapter presents two sets of findings. The first is descriptive: we report on the patterns 

of child care arrangements families used, including who and how many used child care, how 

much and what kinds of child care they used, how usage varied by the program approach of the 

program families were enrolled in, and how satisfied they were with the arrangements they used. 

The second major section documents the difference that Early Head Start made in families’ use 

of child care by comparing both the percentage of families using child care and the amount of 

care used with the experiences of the randomly assigned control group families. First, however, 

we describe how the study measured child care use. 

A. MEASURING CHILD CARE USE IN THE FIRST THREE YEARS OF LIFE 

Our information on the types and characteristics of child care used at children’s 14-month, 

24-month, and 36-month birth dates is taken from the Parent Services Interviews (PSIs) and the 

36-month Parent Interview (PI). We focus on all child care arrangements used for at least 

10 hours per week for 2 weeks or more at 14, 24, and 36 months of age. Because the PSIs were 

administered at three specific times following random assignment (or the families’ initial 

program enrollment) and asked about the family’s child care use in the period since the last PSI, 

we were able to document use by month and link this to children’s ages. This matching of child 

care use to children’s ages worked well for the 14- and 24-month birth dates. Moreover, 

response rates to the PSIs were acceptably high, ranging from 82 percent at 6 months after 

random assignment to 70 percent at 27 months after random assignment. 

 

(continued) 

in home settings varies from state to state, and because information about these arrangements 

came from parent reports, we did not collect information about whether they were registered or 

licensed. Thus, our references to family child care include care provided by relatives and 

nonrelatives, as well as regulated and unregulated care. 
15

Matching child care information from the PSIs to the 36-month birth date posed more 

difficulties, because more than two-thirds of the children had not reached their third birthday 

when the final PSI was collected. To create the 36-month use variables for these children, we 

filled in missing data for the younger children using the less-complete information in the Parent 

Interview conducted when children were approximately 36 months old.2

B. PATTERNS OF CHILD CARE USE BY EARLY HEAD START FAMILIES AND 

CHILDREN 

First, we describe Early Head Start program families’ patterns of child care use when 

children were 14, 24, and 36 months old. We describe the proportion of families who used child 

care, the types of primary child care arrangements they used, the amount of time children spent 

in child care, and the number of child care arrangements they used at each age (see Box II.1).3

1. Proportion of All Early Head Start Families Who Used Child Care 

Most Early Head Start children were in regular child care arrangements at all three ages we 

examined, and the proportion in care increased as the children got older.4 At 14 months of age, 

two-thirds (66 percent) of children were in a regular child care arrangement; the proportion 

 2

The 36-month Parent Interview collected information that is comparable to the PSI data on 

some aspects of child care service use. However, other data collected in the PSI, such as the 

availability of child care during nonstandard work hours, were not collected in the 36-month 

Parent Interview. For these variables, we report on service use at age 24 months only. 

3

The data for these analyses are from the Parent Services Interviews, as described in 

Chapter I. The findings thus apply to all families who completed the PSIs, but describe child 

care use at the time of the birthday-related Parent Interviews. As noted, PSI data are not 

available for parents who completed the last PSI (at about 28 months after enrollment) before the 

child was 36 months old, so that the child care data were taken from the Parent Interview, which 

asked fewer questions. 

4

A “regular” child care arrangement is defined as one that lasted for 10 hours per week or 

more for at least two weeks outside the child’s home (or by a nonrelative in the child’s home). 
16

Box II.1 

Measures of Child Care Use Based on Parent Services Interviews at 7, 16, and 28 Months 

After Random Assignment

Regular Child Care Arrangement – Any child care arrangement used for the focus child for at 

least 10 hours per week that lasted for 2 weeks or more. Child care arrangements included 

care by nonrelatives and by relatives other than a resident parent, and could take place in the 

child’s home, in another home, or in a child care center. This report uses information 

pertaining to the months in which the child was 14, 24, and 36 months old. 

Primary Child Care Arrangement – The type of child care arrangement used for the most hours 

per week in the months when the child was 14, 24, or 36 months old. 

Child Care Center – A child care center, nursery school, or preschool arrangement; a Head Start 

or Early Head Start center; or a school-based child care setting. 

Relative Provider – Care in the child’s home or in another home by a relative of the child. 

Nonrelative Provider – Care in the child’s home or in another home by someone not related to 

the child. 

No Child Care – The child was not using any child care arrangement for at least 10 hours per 

week, and that lasted for 2 weeks or more, during the month when he or she was 14, 24, or 

36 months old. 

Early Head Start Center – The child was cared for in a child care center run by the Early Head 

Start program; the center is expected to meet Head Start Program Performance Standards. 

Number of Child Care Arrangements – Number of different child care arrangements used in the 

months when the child was 14, 24, or 36 months old. Each arrangement must have lasted at 

least 10 hours per week and for 2 weeks or more. 

Hours Per Week of Child Care – Total hours per week in regular child care arrangements used 

concurrently in the months when the child was 14, 24, or 36 months old. 

Use of Child Care During Nonstandard Hours – Child care provider ever cared for the child 

during evenings, in the early mornings, on weekends, or overnight. Respondents self-defined 

what constituted the timing of this care, for example, what “early” morning care meant. 

Percentage Satisfied with Child Care – Proportion of parents who reported being satisfied or 

very satisfied with the child care arrangement used for the most hours since the last interview 

date.
17

dropped slightly at 24 months, and then increased to 84 percent by the time children reached 

36 months of age (Figure II.1). 

Families enrolled in center-based programs were most likely to use regular child care 

arrangements, followed by families enrolled in mixed-approach and home-based programs. This 

pattern is what would be expected given the stated purposes of these Early Head Start program 

approaches. Center-based programs were exclusively center-based, advertised themselves as 

such, and attracted families who were more likely to need and want center care for their children. 

Mixed-approach programs, which included a combination of center care and home visiting 

services were likely to attract more families desiring center care than purely home-based 

programs, but fewer of these families than the center-based programs. 

When the children were 14 months old, 84 percent of families who were enrolled in centerbased programs used child care for their Early Head Start child, compared to 67 percent of 

families in mixed-approach programs and 55 percent in home-based programs. By 36 months, 

however, families in mixed-approach (87 percent) and home-based (81 percent) programs were 

almost as likely as families enrolled in center-based programs (86 percent) to use child care (not 

shown). 

The use of center child care also increased as children got older—from one-third of families 

when children were 14 months old to nearly two-thirds of families by the time children were 

36 months old (see middle section of Figure II.1). This trend is consistent with the majority of 

studies on child care use. Nearly one-fifth of families used an Early Head Start child care center 

at all three age points studied (right-hand section of Figure II.1). 

As expected, more families who were enrolled in center-based programs used center child 

care for their Early Head Start child compared to families in mixed-approach and home-based 

programs. At 14 months, two-thirds of families in center-based programs used a child care 
FIGURE II.1

USE OF CHILD CARE BY EARLY HEAD START CHILDREN

AT 14, 24, AND 36 MONTHS OF AGE

66

60

84

34 31

65

21 18 18

0

908070605040302010

100

14 Months 24 Months 36 Months

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old (see text for details)

Percentage

n = 955 n = 786 n = 966 n = 515 n = 971 n = 445 n = 683 n = 850 n = 888

Any Child Care Arrangement Any Child Care Center Early Head Start Center 

1

8
19

center, compared to one-third of mixed-approach families and 17 percent of home-based 

families.5

 By age 36 months, use of center care had increased among families enrolled in all 

three program approaches. However, as expected, a higher proportion of families in centerbased programs used center care, compared to families enrolled in the other two program 

approaches. Approximately 80 percent of families in center-based programs used center care, 

compared to two-thirds of mixed-approach and half of home-based families (not shown). 

2. Characteristics of Early Head Start Families Who Used Child Care 

The parents’ education level and economic activities at the time they enrolled in Early Head 

Start (that is, the time of random assignment), the household composition at that time, and 

whether the child was firstborn were all associated with the likelihood of using child care. Table 

II.1 shows the proportion of children in child care at 14, 24, and 36 months of age for groups of 

Early Head Start parents (or families) defined by their characteristics at random assignment. 

Specifically, the main patterns are that:

• Birth order: Firstborn children were more likely than later-born children to be in 

care when they were 14 and 24 months old, but not at 36 months. 

• Educational attainment: Parents who had completed high school or had their GED 

were generally more likely to have their children in child care than were parents with 

less education. 

• Living arrangements: Parents who lived alone or with other adults at the time of 

random assignment were more likely to have their children in child care at all three 

age points (in contrast to parents who lived with their spouse). 

• Male presence in the home: Families without a man living in the home at baseline 

were more likely to have their children in care at all three age points, compared with 

families with a man in the home. 

 5

The percentage of families in center-based programs using center care is less than 

100 percent for a number of reasons. For example, some families who were enrolled in centerbased programs dropped out before their child reached 14 months of age and one site did not 

complete its center-based facility until after the data collection. 
20 

TABLE II.1 

PERCENTAGE OF PROGRAM FAMILIES IN CHILD CARE AT 14, 24, AND 36 MONTHS BY FAMILY CHARAC

Age of Child 14 Months 24 Months 

Family Characteristics at Enrollment 

Total Sample 

Size 

Percent in 

Care 

Total Sample 

Size 

Percent in 

Care 

Tot

Child Is Firstborn 619 71 493 65 Child Is Later Born 368 60 317 53 Parent’s Education Is Less than 12 years 433 63 361 56 Parent’s Education Is 12 years or GED 272 67 226 62 Parents Education Is More Than 12 Years 254 73 206 65 Parent Lives with Spouse 250 48 218 39 Parent Lives with Other Adults 383 72 317 71 Parent Lives Alone with Child 364 74 285 64 Adult Male Not in Household 607 72 492 66 Adult Male in Household 390 58 328 51 Parent Employed 234 82 198 76 Parent in School/Training 218 78 174 69 Parent Unemployed/Out of the Labor Force 512 56 421 49 White, Non-Hispanic 368 64 303 54 Black, Non-Hispanic 363 78 285 71 Hispanic 213 55 189 53 Other Race/Ethnicity 36 58 28 50 Source: Background characteristics information gathered at enrollment. Information on child care collected from the Parent Ser

the Parent Interviews (PIs). 

Note: Most children had not reached their 36-month birthday by the time the 26-month PSI was collected. If the child was 3

child care information was obtained from the PSI. If the child was not 36 months old at the time of the last PSI, 36-mowas taken from the 36-month birthday PI. The background characteristics above are the only ones for which the distributnot in care significantly differed at any time point. 
21

• Employment status: Parents employed at baseline were more likely to have their 

children in care at 14 and 24 months, but not when children were 36 months old. 

Parents who were out of the labor force and not in school or training at baseline were 

less likely to have their children in care at all three ages. 

• Race/ethnicity: African American parents were more likely to use child care at all 

three ages than White or Hispanic parents, although the difference in usage was 

considerably smaller when the children were 36 months old. 

3. Types of Primary Child Care Arrangements Used 

We next examined the primary child care arrangements of Early Head Start families, that is, 

the regular arrangement that the child was in for the most hours per week. The primary child 

care arrangement could be an Early Head Start center, another child care center in the 

community, or some form of family child care. 

Among all Early Head Start children using child care, center care was the most common 

primary child care arrangement at all age points (Figure II.2), which differs from the pattern of 

infant-toddler child care arrangements found in the general population. This probably reflects 

the fact that many Early Head Start programs provided center care. Approximately one in five 

Early Head Start families used a relative (most often, a grandparent or great-grandparent) as their 

child’s primary child care provider. One in 10 families used a nonrelative, home-based 

provider—such as a licensed family child care home or a friend or neighbor—as the Early Head 

Start child’s primary child care provider. 

Although Early Head Start families were more likely to use center care as their primary 

arrangement for the child at any age, the proportion using center care increased substantially as 

the children became older, a trend consistent with child care choices observed in the general 

population (Capizzano, Adams, and Sonenstein 2002; Ehrle, Adams, and Tout 2001; and Smith 

2002). When the children were 14 and 24 months of age, 30 percent of families relied primarily 
FIGURE II.2

PRIMARY CHILD CARE ARRANGEMENTS OF EARLY HEAD START CHILDREN 

AT 14, 24, AND 36 MONTHS OF AGE

34

40

17

5 4 4

14 12 12

6 5 7

10 10 12

30 30

48

0 0 1 0

908070605040302010

100

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old

No Child Care Parent/

Stepparent

Grandparent Other

Relative

Nonrelative

Provider

Child Care

Center

Other

(n = 949) (n = 985) (n = 681)

14 Months 24 Months 36 Months

2

2
23

on a child care center for their Early Head Start child. By age 36 months, nearly half of families 

(48 percent) used a child care center as their child’s primary arrangement (Figure II.2). 

At each age, the type of primary arrangement also varied by the program approach Early 

Head Start families enrolled in. As expected, families who were enrolled in center-based 

programs were more likely than families in home-based or mixed-approach programs to use 

child care centers at 36 months of age (as seen in Figure II.3, the percentage using child care 

centers across the three program approaches was 68, 36, and 50 percent, respectively). When 

their children were 36 months of age, families enrolled in home-based programs were most 

likely to use relatives as primary child care providers (27 percent); comparable percentages for 

families in center-based and mixed-approach programs were 14 and 24 percent, respectively 

(Figure II.3). Use of nonrelative, family child care providers across program approaches 

followed a pattern similar to the patterns of using relative providers. Families in home-based 

programs were most likely to use a nonrelative, family child care provider (15 percent), 

compared to families in center-based (3 percent) and mixed-approach (13 percent) programs 

(Figure II.3). 

A substantial proportion of children received care in their primary child care arrangement 

during nonstandard work hours on at least one occasion. For example, at 24 months of age, 

34 percent of all children had ever received care in their primary child care arrangement during 

evening hours, 61 percent during early morning hours, 21 percent during weekend hours, and 

16 percent during overnight hours (Figure II.4).6

 6

These percentages total more than 100 percent because some primary nonstandard 

arrangements took place in more than one time period (for example, during evenings and 

weekends). Respondents self-defined what constituted “evening,” “early morning,” and 

“weekend” hours. 
FIGURE II.3

PRIMARY CHILD CARE ARRANGEMENTS FOR EARLY HEAD START CHILDREN 

AT 36 MONTHS OF AGE, BY PROGRAM APPROACH

68

36

50

14

27

24

3

15 13 15

22

13

0

908070605040302010

100

Child Care Center Relative Provider Nonrelative Provider No Child Care

Center-Based Programs Home-Based Programs Mixed-Approach Programs

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

(n = 283) (n = 236) (n = 157)

2

4
FIGURE II.4

PERCENTAGE OF EARLY HEAD START CHILDREN WHO RECEIVED THEIR PRIMARY

CHILD CARE DURING NONSTANDARD HOURS, AT 24 MONTHS OF AGE,

BY PROGRAM APPROACH

34 29

40

29

61

50

69

59

21

10

26

21

16 15

19

14

0

908070605040302010

100

Evening Early Morning Weekend Overnight

Full Sample Center-Based Programs Home-Based Programs Mixed-Approach Programs

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after program enrollment.Note: The percentages are average percentages of children who have a primary arrangement across programs and within each program

h 

d 

i

ht

d f

B

i

th

785 f

ili

h

t

d 

i

t 

t 24 

th

(n = 164) (n = 158) (n = 169) (n = 491)

2

5
26

The primary child care providers for the families enrolled in home-based programs were 

more likely to offer care during nonstandard hours than were the primary providers used by 

families in center-based or mixed-approached programs. For instance, 40 percent of primary 

providers used by home-based families had ever provided evening care, compared to 29 percent 

of the primary providers used by center-based and mixed-approach families. These differences 

may be due, in part, to the higher proportion of home-based families who used relative and 

nonrelative family child care providers as their primary child care arrangement, in contrast to the 

proportion of center-based and mixed-approach families. Because they cared for the child at 

home, relatives and other family child care providers may have been able to offer more flexible 

hours of care than child care centers could. 

4. Intensity of Child Care Service Use 

The average number of hours that Early Head Start children—across all 17 programs—spent 

in their regular child care arrangements increased as they got older, as is typically the case. 

Considering all children in the sample, including those who had zero hours in child care, at age 

14 months, children spent 29 hours per week, on average, in their regular child care 

arrangements (including Early Head Start centers and any other arrangements they were in), 

compared to 32 hours a week by 36 months of age (Figure II.5). Nearly half (49 percent) of the 

Early Head Start children spent at least 30 hours in their regular child care arrangements at 

14 months, and by 36 months of age, nearly two-thirds (65 percent) spent at least 30 hours a 

week in care (Figure II.6). The proportion of children who spent 30 or more hours a week in 

their regular child care arrangements stayed about constant (or declined slightly) between 14 and 

24 months, then increased substantially by 36 months across all three program approaches. At 
FIGURE II.5

AVERAGE HOURS PER WEEK IN CHILD CARE FOR EARLY HEAD START 

CHILDREN AT 14, 24, AND 36 MONTHS OF AGE

29

22

32

13

11

22

8

6

50

504540353025201510

*

Hours

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

N

t

Th

t

t

d 

i

ht

d f

14 Months 24 Months 36 Months

n = 882 n = 725 n = 973 n = 535 n = 988 n = 657 n = 852 n = 900

Any Child Care, Including 

Early Head Start

Any Child Care Center, 

Including Early Head Start

Early Head Start Center

2

7
FIGURE II.6

PERCENTAGE OF EARLY HEAD START CHILDREN IN CHILD CARE FOR AT LEAST

30 HOURS PER WEEK AT 14, 24, AND 36 MONTHS OF AGE,

BY PROGRAM APPROACH

49

66

37

50

45

64

32

49

65

74

51

67

0

908070605040302010

100

Full Sample Center-Based Programs Home-Based Programs Mixed-Approach Programs

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after program enrollment and a Parent 

Interview completed when children were approximately 36 months old.

n = 882 n = 185 n = 296 n = 401

24 Months 14 Months 36 Months

n = 725 n = 173 n = 232 n = 320 n = 657 n = 172 n = 217 n = 268

2

8
29

all three ages, center-based programs had the highest proportion of children in care for 30 or 

more hours a week, followed by mixed-approach and then home-based programs (Figure II.6). 

The average number of hours that children spent in child care centers nearly doubled 

between 14 and 36 months of age. At 14 months, children spent an average of 13 hours a week 

in center child care (including both Early Head Start and community centers, and averaging in 

those who spent no time in child care). By 36 months, they spent 22 hours a week, on average, 

in child care centers (see middle section of Figure II.5). Families in center-based programs—as 

we would expect—used the most hours of center care, followed by families in mixed-approach 

and home-based programs. When their children were 36 months old, two-thirds of center-based 

families, half of mixed-approach families, and 40 percent of home-based families used at least 

30 hours a week of center care for their Early Head Start child (Figure II.7). 

5. Number of Regular Child Care Arrangements Used 

Most Early Head Start families used only one regular child care arrangement for their Early 

Head Start child at 24 months of age. Fifteen percent, however, used more than one regular, 

concurrent arrangement (not shown). Across program approaches, families in center-based 

programs were the ones most likely to use multiple concurrent child care arrangements, 

suggesting that Early Head start centers did not provide child care during all the hours that 

families needed it. Thirty percent of center-based families used multiple concurrent 

arrangements, compared to 15 percent of mixed-approach families and 6 percent of home-based 

families. 

6. Early Head Start Families’ Satisfaction with Child Care Arrangements 

Parents seek many different features in a child care setting. For infants and toddlers, they 

look for a warm, supportive provider, a safe environment, and attention to health issues (Larner 
FIGURE II.7

PERCENTAGE OF EARLY HEAD START CHILDREN IN CENTER CHILD CARE 

FOR AT LEAST 30 HOURS PER WEEK AT 14, 24, AND 36 MONTHS 

OF AGE, BY PROGRAM APPROACH

28

59

14

23 24

51

10

19

52

68

40

54

0

908070605040302010

100 Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old

n = 973 n = 207 n = 318 n = 448

24 Months 14 Months 36 Months

n = 852 n = 195 n = 267 n = 390 n = 535 n = 164 n = 175 n = 192

Full Sample Center-Based Programs Home-Based Programs Mixed-Approach Programs

3

0
31

and Phillips 1994). Parents also look for an affordable arrangement, a location close to home or 

work, hours of care that coincide with their needs, providers they can trust not to harm the child, 

and cultural continuity (Emlen 1998; Mitchell, Cooperstein, and Larner 1992; and Porter 1991). 

Parents may also need a setting that can accommodate children of very different ages. Because 

these needs may compete with one another, parents must often make tradeoffs among desired 

features as they choose among the available arrangements. 

Perhaps because parents make tradeoffs among desirable features of care and choose what 

they perceive to be the best of the available arrangements, past research has found that parents 

typically report high levels of satisfaction with their child care arrangements. In summarizing 

the literature on parents’ satisfaction with care, Phillips (1995) noted that about 95 percent of 

low-income families with children under age 5 in care say they are satisfied or highly satisfied. 

Families enrolled in Early Head Start and using child care also expressed a high degree of 

satisfaction with the child care they used for their children. At an average of 28 months after 

program enrollment, 95 percent of families expressed satisfaction with their recent primary child 

care arrangements (Figure II.8). Nearly three-fourths of families were very satisfied. At 7 and 

16 months after enrollment, levels of satisfaction were similar to those at 28 months. 

When asked specifically about aspects of the primary child care arrangement that are 

associated with the quality of the child’s experience, Early Head Start parents reported similarly 

high levels of satisfaction. For example, 97 percent were satisfied with the amount of attention 

their children received, 93 percent were satisfied with how much their children were learning, 

97 percent were satisfied with how safe their children were, and 96 percent were satisfied with 

how good their provider was with children. 

The proportion of parents who were very satisfied with these aspects of child care ranged 

from 68 to 76 percent. A somewhat lower proportion of parents in home-based programs said 
FIGURE II.8

SATISFACTION WITH PRIMARY CHILD CARE ARRANGEMENTS 28 MONTHS AFTER 

ENROLLMENT

95 97 93 97 96

73 71 68 76 76

0

80604020

100

Overall How Much Attention

Child Receives

How Much Child Is

Learning

Safety Provider Good With

Kids

Satisfied or Very Satisfied Very Satisfied

SOURCE: Parent Services Follow-Up Interviews completed an average of 28 months after enrollment.NOTE

Th

t

t

d 

i

ht

d f

Percentage

n = 714 n = 711 n = 710 n = 713 n = 713

3

2
33

they were very satisfied with these aspects of their child care arrangements, compared to parents 

in center-based and mixed-approach programs (not shown). For example, while 79 percent of 

center-based parents and 78 percent of mixed-approach parents were very satisfied with their 

children’s safety in child care, 73 percent of home-based parents were very satisfied. In the area 

of child learning, more center-based parents were very satisfied (74 percent), compared to 

68 percent of mixed-approach and 65 percent of parents in home-based programs (not shown). 

Research by Emlen and colleagues (1998, 1999) indicates that parents’ reports of high levels 

of satisfaction with child care can mask concerns over arrangements that are not ideal, although 

they may be perceived as the best available for the family. Emlen’s research showed that while 

93 percent of parents rated their child care arrangements as perfect, excellent, or good, fewer said 

they would choose the arrangement again (84 percent), and an even smaller proportion said that, 

“the care I have is just what my child needs” (68 percent). Among Early Head Start families at 

28 months after enrollment, nearly one-third of parents said they would prefer to change child 

care arrangements if cost were not a barrier (not shown). However, the proportion of parents 

who wanted to change child care arrangements dropped over time—from 38 percent at 7 months 

after enrollment to 30 percent at 16 months and 29 percent at 28 months—suggesting that as 

children became older, parents were more likely to find a child care arrangement they liked. 

The proportion of parents who wanted to change child care arrangements varied somewhat 

by program approach. Families in home-based programs were somewhat more likely 

(32 percent) to prefer a different child care arrangement at 28 months after enrollment, compared 

to 26 percent of parents in mixed-approach and 28 percent in center-based programs (not 

shown). 

Of those families who said they would like to change child care arrangements, 80 percent 

preferred a center arrangement at 28 months after enrollment—either in a child care center 
34

(49 percent) or in a nursery school, preschool, or Head Start center (31 percent) (Figure II.9). 

Smaller proportions of families at 28 months preferred relative providers (8 percent), nonrelative 

providers such as friends or neighbors (5 percent), or other types of arrangements (6 percent). 

The proportion of families who preferred a center arrangement increased over time, perhaps 

because parents’ child care preferences shifted from home to center settings as their children got 

older. At 7 months after enrollment, 67 percent of those wanting to change arrangements wanted 

center care. By 16 months after enrollment, that proportion increased to 73 percent (and to 

80 percent at 28 months). Similarly, the percentage of families who wanted to change 

arrangements to relative care decreased over time—from 19 percent at 7 months after 

enrollment, to 15 percent at 16 months, and 8 percent after 28 months in the program. The 

reasons families wanted to change arrangements varied according to the type of arrangements 

they preferred (Figure II.10). Of those who preferred center care, nearly half thought centers 

would help their children learn better, and 20 percent wanted their child to be with other 

children. Families who preferred relative care cited increased safety and convenience as their 

primary reasons for wanting to change arrangements. 

7. Summary of Child Care Use Findings 

Most Early Head Start children were in regular child care arrangements at all three ages (14, 

24, and 36 months), with 84 percent in care at 36 months. Parents using child care differed 

somewhat from those who did not in that child care users were more highly educated, more 

likely to be living alone, more likely to be African American, and more likely to be employed at 

random assignment. The types of primary arrangements used varied by the age of the child. It 

may be useful for programs to know that the percentage of families using center care increases as 

children get older. The amount of care used by families also increases with age, but only 

slightly. Even though some families did not place their children in out-of-home care at all, the 
FIGURE II.9

TYPES OF CHILD CARE ARRANGEMENTS PREFERRED BY EARLY HEAD START

FAMILIES WHO WANTED TO CHANGE ARRANGEMENTS

67

19

8 7

73

15

5

9

80

8 5 6

0

80604020

100

Center Care Relative Care Nonrelative Care Other Arrangements

7 Months 16 Months 28 Months

SOURCE: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment. Sample 

sizes as follows: 7 months: 317 out of 317 who wanted to change; 16 months: 251 out of 264 who wanted to change; 28 months: 284 out of 294 who wanted to change.

Percentage

3

5
FIGURE II.10

MAIN REASONS FAMILIES WOULD WANT TO CHANGE CHILD CARE ARRANGEMENTS,

BY TYPE OF CARE PREFERRED, 28 MONTHS AFTER ENROLLMENT

49

5

11

21

2 2

27

20

0 3

0

80604020

100

So Child Can Learn

Better

Safety Convenience So Child Can Be With

Other Children

So Child Can Be In

Smaller Group

Preferred Center Preferred Relative

SOURCE: Parent Services Follow-Up Interviews completed an average of 28 months after enrollment. N = 287, of the 

294 families who wanted to change.

Percentage

3

6
37

average child spent 29 hours a week in care at 14 months and 32 hours when they were 

36 months old. At all three ages, families enrolled in center-based programs were more likely to 

have their children in child care 30 or more hours per week, with mixed-approach and homebased programs having lower proportions. Early Head Start families were highly satisfied with 

the child care they received, but if they could make a change and did not have to worry about 

costs, about 30 percent would change, and most of them would prefer to use a child care center 

rather than family child care. 

C. IMPACTS OF EARLY HEAD START PROGRAM PARTICIPATION ON 

FAMILIES’ CHILD CARE USE 

As noted in Chapter I, one of Early Head Start’s goals is to ensure families access to needed 

child care. In this section we report the results of our analysis of the impacts that the program 

had on child care use. In the next chapter, we describe impacts on the quality of the care used by 

Early Head Start and control group families. 

1. Approach to Analyzing Impacts on Child Care Use 

The impacts of the Early Head Start programs on child care use and amount (or intensity) of 

use were analyzed using the same methods used for analyzing service use in the national 

evaluation’s interim and final reports (see ACYF 2001; and ACF 2002b, Chapter II). That is, we 

estimated regression-adjusted means of child care usage for Early Head Start program and 

control group families to produce precise impact estimates adjusted for any differences in 

observable characteristics of program and control group families due to random sampling and 

interview nonresponse. All eligible applicants who completed a 28-month PSI were included in 

these analyses. We also weighted the impacts at each site equally in analyzing the overall 

impacts of Early Head Start on child care use. 
38

We included a large number of explanatory (control) variables in the regression models 

using data collected at baseline with the Head Start Family Information System (HSFIS). Child 

care use data were obtained in the Parent Services Interviews (PSI), but, as noted earlier, we 

created age-related child care use variables by linking PSI data to the age of the child, 

supplementing the later PSI variables with data from the 36-month Parent Interviews to fill in 

missing data for children who were not yet 36 months old when the final PSI was completed. 

2. Early Head Start Program Impacts on the Percentage of Families Using Child Care 

and on the Amount of Care Used 

While most families in both program and control groups used child care, Early Head Start 

children were significantly more likely than control children to be in child care at all three ages. 

These program-control differences (that is, the impact of Early Head Start program participation) 

became smaller as children got older and increasing numbers of control families placed their 

children in child care. At 14 months of age, 66 percent of Early Head Start children were in 

child care, compared to 57 percent of control group children. By 36 months of age, the 

percentage of Early Head Start children in any child care rose to 84 percent, while the percentage 

of control group children in child care increased to 78 percent (Figure II.11)—a smaller 

difference, though still significantly different statistically. 

The impact of Early Head Start program participation on families’ use of center care was 

greater than the impact on any child care use, and this was true at all three ages (as seen by 

comparing Figures II.11 and II.12). At 14 months of age, 34 percent of program families used a 

child care center (including those operated by Early Head Start and community centers), 

compared to 17 percent of control families (Figure II.12). While the proportion of children in 

center care increased in both groups as children got older, the size of the impact on use of center 

child care decreased somewhat, as more control families placed their children in child care 
FIGURE II.11

IMPACTS ON CHILD CARE USE AT 14, 24, AND 36 MONTHS OF AGE

66.4

56.5

60.5

51.3

84.4

77.7

0

908070605040302010

100

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

Note: All percentages are regression-adjusted means estimated using models that weight each site equally. The differences between 

d 

l f

ili

i

d i

li

ibl

li

Program Group Control Group

n = 997 n = 916 n = 820 n = 749 n = 715 n = 608

14 Months*** 24 Months*** 36 Months***

3

9
FIGURE II.12

IMPACTS ON USE OF CENTER CHILD CARE AT 14, 24, AND 36 MONTHS OF AGE

34.2

16.8

31.5

15.9

64.3

52.2

0

908070605040302010

100

Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

Note: All percentages are regression-adjusted means estimated using models that weight each site equally. The differences between 

d 

t

l f

ili

ti

t

d i

t

li

ibl

li

t

n = 1,009 n = 942 n = 888 n = 811 n = 540 n = 443

14 Months*** 24 Months*** 36 Months***

Program Group Control Group

4

0
41

centers. By the time they were 36 months old, nearly two-thirds (64 percent) of program group 

children were in center care, compared to approximately one-half (52 percent) of control group 

children. 

Not only did participation in Early Head Start programs make it more likely that families 

would use any child care: it also made a significant difference in the amount of child care that 

families used, compared with control group families. By the time children were 36 months old, 

program children were in any child care for 32 hours a week and in center care for 23 hours a 

week, on average (Figures II.13 and II.14). In contrast, control group children spent an average 

of 28 hours a week in any child care and 18 hours a week in center care, about four-fifths of the 

center care time used by program families. 

Early Head Start families were significantly more likely than control families to use 

multiple, concurrent child care arrangements (more than one arrangement at a time). At 

24 months of age, 15 percent of program families used concurrent arrangements, compared to 

11 percent of control families (not shown). Program families may have had a greater need for 

multiple arrangements to cover all the hours during which they needed child care because they 

used significantly more center care than control families. Centers may have been less likely than 

family child care providers, including relatives, to offer care during nonstandard hours, such as 

evenings and weekends. 

Early Head Start families were significantly less likely to use child care during nonstandard 

hours—control group families were significantly more likely to have ever used child care during 

evenings and weekends than were Early Head Start families (Figure II.15). Control group 

families used a higher proportion of family child care providers, such as relatives and other inhome child care providers, who may have been able to offer more flexible hours of care. In 
FIGURE II.13

IMPACTS ON AVERAGE HOURS PER WEEK IN ANY CHILD CARE 

AT 14, 24, AND 36 MONTHS OF AGE

28.7

23.6 23.4

19.4

32.1

28.1

50

504540353025201510

Hours

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

Note: All percentages are regression-adjusted means estimated using models that weight each site equally. The differences between 

Program Group Control Group

n = 882 n = 827 n = 725 n = 665 n = 657 n = 551

14 Months*** 24 Months*** 36 Months***

4

2
FIGURE II.14

IMPACTS ON AVERAGE HOURS PER WEEK IN CENTER CHILD CARE 

AT 14, 24, AND 36 MONTHS OF AGE

12.2

6.7

11.3

5.7

22.5

17.8

50

504540353025201510

Hours

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment and a Parent Interview

completed when children were approximately 36 months old.

Note: All percentages are regression-adjusted means estimated using models that weight each site equally. The differences between 

Program Group Control Group

n = 973 n = 926 n = 852 n = 795 n = 535 n = 438

14 Months*** 24 Months*** 36 Months***

4

3
FIGURE II.15

IMPACTS ON USE OF CARE DURING NONSTANDARD HOURS IN PRIMARY CHILD CARE 

ARRANGEMENTS AT 24 MONTHS OF AGE

35.3

46.8

58.7

61.1

20.7

28.2

16.9

21.0

0

908070605040302010

100 Percentage

Source: Parent Services Follow-Up Interviews completed an average of 7, 16, and 28 months after enrollment.Note: All percentages are regression-adjusted means estimated using models that weight each site equally. The differences between 

program and control families are estimated impacts per eligible applicant.

Program Group Control Group

n = 482 n = 360 n = 482 n = 360

Evenings*** Early Mornings Weekends** Overnight

n = 482 n = 360 n = 482 n = 360

4

4
45

contrast, program group families were more likely to use center arrangements, which are less 

likely to be open during evenings and weekends.

Conclusion 

This chapter has shown that the families with infants and toddlers enrolled in Early Head 

Start programs that were included in the national evaluation used substantial amounts of child 

care, and that the amount of care used increased as the children got older. Child care was 

provided by Early Head Start as well as by community providers, reflecting the communityoriented nature of Early Head Start’s approach to child care as envisioned by the Advisory 

Committee on Services for Families with Infants and Toddlers. Early Head Start families used a 

variety of types of child care and were highly satisfied with the care they received. As hoped by 

the Early Head Start program designers, the program had substantial and significant impacts on 

the percentage of families using any child care, as well as on the amount of care they used. The 

impacts on the percentage of families using center care and the amount of center care used were 

even larger than when all types of child care arrangements were considered. 

47 

III. QUALITY OF CHILD CARE USED BY EARLY HEAD START FAMILIES 

AND PROGRAM IMPACTS ON THE QUALITY 

OF CHILD CARE FAMILIES USED 

Early Head Start program designers, as reflected in the report of the Advisory Committee on 

Services for Families with Infants and Toddlers, anticipated that Early Head Start programs 

would not only enable families to access the care the needed (as we saw in Chapter II), but also 

enhance the quality of that care. Thus, Early Head Start was expected to increase the use of 

good-quality child care by low-income families with infants and toddlers, whether that care is 

provided by Early Head Start programs directly or by community child care providers (U.S. 

Department of Health and Human Services 1994). The Early Head Start evaluation was 

designed so that data collected on child care quality would enable us to assess the extent to 

which the programs included in the research made a difference in the quality of the care the 

families enrolled their children in. The randomized design of the evaluation enables us to 

present strong evidence of the extent to which Early Head Start programs created better-quality 

center child care experiences for the enrolled children when compared with their randomly 

assigned control-group counterparts.

In this chapter, after presenting our methods and procedures, we report data that describe the 

levels of quality of care that Early Head Start children received, using a range of quality 

indicators. We then use data from a subset of the programs to examine the extent to which these 

Early Head Start programs made a difference in the proportion of families placing their children 

in good-quality center care arrangements, and in the levels of quality of center child care, when 

the experience of Early Head Start children is contrasted with that of the control group. Finally, 

we discuss regression analyses conducted within the Early Head Start sample suggesting that 
48 

high levels of both child care use and child care quality may contribute to more-positive 

developmental outcomes for Early Head Start children. 

A. MEASURING CHILD CARE QUALITY IN THE EARLY HEAD START 

EVALUATION 

1. Child Care Settings Included in this Study 

We assessed child care quality through direct observation at the time of the child 

assessments, when the children were 14, 24, and 36 months old. At these ages, the child care 

settings eligible for observational assessment shared the following characteristics: 

• Regular Child Care Arrangement—We observed arrangements in which the child 

spent 10 or more hours per week for at least two weeks prior to the interview outside 

the child’s home (or by a nonrelative in the child’s home). These criteria are the 

same as those used in the NICHD Study of Early Child Care. The hours per week 

criterion ensures that the child’s exposure to the arrangement meets a minimum 

threshold for it to potentially influence his or her development. The two-week 

criterion ensures that the provider and child are minimally acquainted so that typical 

interactions can be observed. 

• Relatives and Nonrelatives—The focus of the observational study was care outside 

the child’s home with relatives or nonrelatives, and in-home care settings with 

nonrelatives. These child care arrangements provide a sufficient distinction either in 

the caregiver (a nonrelative) or the place (out of the child’s home) to warrant 

intensive data collection as a distinct aspect of the child’s environment. Care 

provided by a relative in the child’s own home was considered to be very similar to 

parental care; therefore, we excluded these settings from the observational study. 

• “Family Child Care”—We refer to all observed in-home care settings as family child 

care, whether care was provided by a relative or nonrelative caregiver. Because the 

regulation of home-based care settings varies from state to state, and because 

information about these arrangements came from parent reports, we did not collect 

information about whether these home-based child care settings were registered or 

licensed. Thus, our references to family child care include care provided by relatives 

and nonrelatives, as well as regulated and unregulated care. 

• Primary Child Care Arrangement—If more than one child care arrangement met 

these criteria, the arrangement used for the most hours per week was chosen for the 

observational study. 
49 

The total number of child care settings that could be observed was thus influenced by 

several factors: (1) the response rate to the birthday-related assessment (parents who were not 

interviewed in a particular wave of these assessments could not be asked about child care 

arrangements); (2) the rates of child care use; (3) the rates of use of out-of-home or nonrelative 

child care (settings “eligible” for observation); (4) parents’ willingness to allow interviewers to 

contact their child care providers; (5) our success in locating the providers; and (6) the providers’ 

willingness to be interviewed and observed. 

2. Response Rates 

Table III.1 shows how these factors combined to produce the response rates in the 

observational study of child care at each of the birthday-related assessment points. At each time 

point, between 70 and 80 percent of the parents completed an interview. Since half or fewer of 

the families interviewed were using an “eligible” child care arrangement for the child, only 32 to 

35 percent of the original full sample of children were using child care that could be observed at 

any point. Observations were completed with between 53 percent and 56 percent of the 

“eligible” arrangements at each point, with a much higher completion rate for center care 

arrangements (approximately 70 percent) than for family, relative, and other home-based care 

arrangements (approximately 32 percent). 

The pattern of response rates and the number of observations varied considerably by site, in 

part reflecting the mix of child care arrangements in each site and the relative difficulty of 

completing observations in family child care settings.1

 In some sites, the level of non-response 

was substantial, and in general, nonresponse was quite high among the in-home providers. 

 1

Appendix Tables A.1, A.2, and A.3 provide response rates by type of care and by site for 

the three data collection periods. 
50 

TABLE III.1 

RESPONSE RATES TO THE CHILD CARE OBSERVATIONS 

Description of Sample 

14-Month 

Child Care 

Observations 

24-Month 

Child Care 

Observations 

36-Month 

Child Care 

Observations 

Number of Children in the Sample 3,001 3,001 3,001 

Number of Families Responding to Parent Interview/Child 

Assessment 2,344 2,166 2,110 

Percentage of all Children 78.1 72.2 70.3 

 

Number of Children in an Eligible Child Care Arrangementa 962 976 1,060 

Percentage of all Children 32.1 32.5 35.3 

 

Number Whose Provider Was Located, Agreed to Participate, 

and Completed the Observation 509 547 596 

Percentage of All Children 17.0 18.2 19.9 

 

Percentage of Children with Eligible Arrangements Who Had a 

Complete Observation 52.9 56.1 56.2 

Center Care 70.4 72.9 69.4 

Family Child Care 32.4 33.7 30.1 

 

In the Subset of Sites Included in the Impact Analysis, the 

Percentage of Children with Eligible Arrangements Who Had a 

Complete Observation 66.9 65.9 68.5 

Center Care 81.4 79.4 82.1 

Program 85.1 85.5 84.2 

Control 72.1 66.1 78.7 

Family Child Care 35.4 31.2 27.7 

Source: Parent Interviews and observations of child care arrangements conducted when children were 

approximately 14, 24, and 36 months old. 

Note: Sites included in the impact analysis of child care quality include all four sites with center-based Early 

Head Start programs and four mixed-approach sites at all three time periods and an additional mixedapproach site at 36 months.

a

Eligible arrangements include care outside the child’s home (with a relative or nonrelative) and care in the child’s 

home with a nonrelative. The child must have been in the child care arrangement for at least 10 hours per week and 

have 2 or more weeks’ experience in that arrangement. If the child was in more than one child care arrangement 

that met these criteria, the arrangement used for the most hours per week was chosen for the observation. 
51 

Therefore, we focused the analysis of child care quality in sites with higher response rates 

overall. Not surprisingly, a higher proportion of families in center-based program sites and some 

mixed-approach sites were using child care, and care that met the study’s eligibility criteria. 

Response rates were high in these sites for center care arrangements, though not for family 

child care arrangements. Table III.1 shows that, in the four center-based sites and the four (at 

age 2) and five (at age 3) mixed-approach sites included in our analysis of the impact of Early 

Head Start on child care environments, between 79 and 82 percent of the eligible center child 

care arrangements were observed, while between 28 and 31 percent of the family child care 

arrangements were observed. Therefore, our characterization of the average quality of care 

experienced by children in the study is more reliable for children in centers than in home-based 

or family child care. Accordingly, we focused the impact analysis on center child care 

arrangements in this subset of sites, for a total of 315 to 390 child care observations. By 

program-control status, interviewers observed a somewhat higher proportion of center child care 

arrangements for Early Head Start program children than for control-group children in these 

sites, possibly reflecting a greater ease of access to Early Head Start-sponsored child care 

settings. 

3. Procedures and Instruments Used 

To conduct the observational assessments of child care, trained observers visited the child 

care settings for two to three hours in the morning. Interviewer/observers conducted interviews 

with center directors and providers and observed the classroom or home in order to complete 

several structured observation protocols. The observational measures used are described in 

Box III.1, and our procedures for training and achieving inter-observer reliability are 

summarized in Appendix B. 
52 

BOX III.1 

OBSERVATIONAL MEASURES OF CHILD CARE ENVIRONMENTS USED IN THE EARLY HEAD 

START EVALUATION 

Infant-Toddler Environment Rating Scale (ITERS; Harms, Cryer, and Clifford 1990; 14 and 24 months) – 

measures the global quality of child care for infants and toddlers in center child care settings. Items measure the 

quality of furnishings and display for children, personal care routines, listening and talking, learning activities, 

interaction, and program structure. (Three items on adult needs were omitted from the version used in this study.) 

Items are coded on a seven-point scale from inadequate (1) and minimal (3) to good (5) and excellent (7). The total 

score is the average across all 33 items and can range from 1 to 7. 

Early Childhood Environment Rating Scale-Revised (ECERS-R; Harms, Clifford, and Cryer 1998; 

36 months) – measures the global quality of child care for preschoolers in center settings. Items measure the quality 

of space and furnishings, personal care routines, language and reasoning, activities, interaction, program structure, 

and provisions for parents and staff. (Four items on parents/staff were omitted from the version used in this study.) 

Items are coded on a seven-point scale from inadequate (1) and minimal (3) to good (5) and excellent (7). The score 

is the average across all 39 items and can range from 1 to 7. 

Family Day Care Rating Scale (FDCRS; Harms and Clifford 1989; 14, 24, and 36 months) – measures the 

global quality of child care for infants, toddlers, and preschoolers in family child care settings. Items measure the 

quality of space and furnishings, basic care, language and reasoning, learning activities, social development, and 

adult needs. Items are coded on a seven-point scale from inadequate (1) and minimal (3) to good (5) and excellent 

(7). The total score is the average across the 31 items we used and can range from 1 to 7. 

Child-Adult Ratio (14, 24, and 36 months) – Observer’s count of the number of children and caregivers in the 

classroom at the time of the observation. The number used in our analysis was the average of up to six observations 

over the 2-hour observation period. 

Arnett Caregiver Interaction Scale (Arnett 1989; 14, 24, and 36 months) – measures the quality of the 

caregiver’s interactions with children in both center and family child care settings. Items are scored based on a 

2.5 hour observation of the primary caregiver in the child care setting, and measure the extent to which the caregiver 

spoke warmly, seemed distant or detached, exercised rigid control, or spoke with irritation or hostility. Items are 

coded on a 4-point scale from “not at all” characteristic of the caregiver (1) to “very much” characteristic of the 

caregiver (4). We conducted factor analyses at each time point, but since no clear set of similar subscales emerged 

across time, we report our findings based on the full Arnett score, the average rating across all 26 items. 

Child-Caregiver Observation System (C-COS; Boller, Sprachman, and the Early Head Start Research 

Consortium 1998; 24 and 36 months) – measures the types of caregiver interaction and child activities specifically 

pertaining to the focus child based on six 5-minute observations. During each 5-minute observation, observers 

watched the focus child for 20 seconds and then indicated whether a specific set of child and caregiver behaviors 

occurred (the recording phase lasted 10 seconds). Over the 2-hour observation, a total of 60 20-second childcaregiver observations were made. 

Incidents of Any Caregiver Talk – the number of observation periods in which the caregiver directed an 

utterance to the focus child or to a group that included the child. Scores can range from 0 (no caregiver 

speech toward the child was observed) to 60 (caregiver speech toward the child was observed during each 

observation period). 

Incidents of Caregiver Responding to Child – the number of observation periods in which the caregiver 

responded to the child’s speech or bid for attention. Scores could range from 0 to 60. 

Incidents of Caregiver Initiating Talk with Child – the number observation periods in which the caregiver 

initiated talk without the child first speaking to the caregiver. Scores could range from 0 to 60. 

Incidents of Negative Behavior – the number of observation periods in which the child was wandering or 

unoccupied; upset or crying; or was observed hitting, biting, or bothering another child; or was observed 

being hit, bitten, or bothered by another child.
53 

Central to the structured observations was a global assessment of the quality of the child 

care setting using a widely used family of measures that vary by the age of the child and the type 

of setting. When children were 14 and 24 months of age, observations of center care were 

conducted using a slightly shortened version of the Infant-Toddler Environment Rating Scale 

(ITERS; Harms, Cryer, and Clifford 1990). For children at age 3, we used the Early Childhood 

Environment Rating Scale-Revised (ECERS-R; Harms, Clifford, and Cryer 1998). At all three 

age points, we observed the quality of family or home-based child care using the Family Day 

Care Rating Scale (FDCRS; Harms and Clifford 1989). In all settings, observers also recorded 

child-teacher ratios and group sizes, to obtain more reliable data than would be obtained from 

provider self-reports. 

The observation protocol also included another frequently used global quality measure, the 

Arnett Caregiver Interaction Scale (Arnett 1989). Observers completed the 26-item rating scale 

at the end of the observation period, based on their observations of the primary caregiver’s 

behavior toward children in the classroom throughout the observation period. 

To supplement these standard, widely used global measures of quality, we developed a new 

measure that provided child-level data for specific teacher-child interactions: the ChildCaregiver Observation System (C-COS; Boller, Sprachman, and the Early Head Start Research 

Consortium 1998). The C-COS drew upon, and included features of, two existing procedures: 

(1) the Observational Record of the Caregiving Environment (ORCE; NICHD Early Child Care 

Research Network 1997) and (2) the Adult Involvement Scale (Howes and Smith 1995). C-COS 

was designed to capture the experiences of individual children by time-sampling aspects of 

caregivers’ interactions with the Early Head Start sample child in the center classroom or family 

child care home. As described in Box III.1, interactions were coded during the same time period 
54 

that observers were completing the ITERS, ECERS-R, FDCRS, and adult-child counts. The CCOS was collected only when children were 24 and 36 months old. 

B. QUALITY OF CHILD CARE USED BY EARLY HEAD START FAMILIES 

This section presents descriptive data on the quality of the child care arrangements Early 

Head Start children were in, both in centers and family child care homes. All observations of the 

quality of child care experienced by children in the research sample are based on care 

arrangements that were determined to be eligible for observation, as described earlier. First, we 

present data on quality obtained using standard measures of global quality (ITERS and 

ECERS-R for center care, FDCRS for family child care, Arnett Caregiver Interaction Scale in 

both types of settings), and child-adult ratios. Then, in the second part of this section, we present 

the caregiver-child interaction data from the C-COS. The third part compares the quality of care 

Early Head Start children received in Early Head Start centers with that received by Early Head 

Start children in community child care centers. 

1. Quality of Child Care Used (Global Measures) 

We first present analyses of the average quality of care experienced by Early Head Start 

program children observed in any center care across all 17 sites. The settings observed include 

center care provided by Early Head Start center-based and mixed-approach programs, care in 

community child care centers that Early Head Start programs partnered with, and care in 

community settings that Early Head Start parents selected on their own, without the assistance of 

the program.2

 As reported in the evaluation’s implementation report, Pathways to Quality 

(ACF 2002c), Early Head Start program partnerships with community child care providers 

 2

In Section C of this chapter, we report the quality of care children experienced in Early 

Head Start centers. 
55 

developed over time. Thus, we expected that as children got older parents would be increasingly 

likely to place their child in community centers that their programs had established partnerships 

with and were instilling and monitoring quality in line with the Head Start Program Performance 

Standards. 

Early Head Start children in center care consistently experienced nearly good or goodquality care on average, as measured by the ITERS and ECERS-R classroom rating scales 

(Table III.2). Furthermore, quality improved slightly as children got older, rising from 4.7 on the 

ITERS at 14 months to 5.0 on the ECERS-R at 36 months, an increase of about one-quarter of a 

standard deviation.3

 The range in average quality ratings was wide for each time period, 

however. ITERS scores ranged from a low of 1.5 in one classroom to 6.8 at another (at 14 and 

24 months), and ECERS-R ratings ranged from 1.2 to 6.8 across center classrooms used by Early 

Head Start families. 

This overall quality of center care that Early Head Start programs achieved for their 

families, regardless of the auspice providing the child care, is rare among large-scale programs. 

One widely cited national study of child care quality found that the average ITERS score across 

infant-toddler classrooms was only 3.4, or between 1 and 1.5 standard deviations below the Early 

Head Start averages for those ages (Cost, Quality, and Child Outcomes Study Team 1995). The 

National Child Care Staffing study found average quality ratings of 3.2 and 3.6 in centers serving 

infants and toddlers, respectively (Whitebook, Howes, and Phillips 1989), again substantially 

lower than what we observed in child care centers used by Early Head Start families. Included in 

this group of centers were Early Head Start centers, which we discuss specifically later in this 

chapter.

 3

It should be noted, however, that because the measure of quality changed also (from the 

ITERS at 14 and 24 months to the ECERS-R at 36 months of age), the change in the 

observational instrument may have contributed to the apparent age difference found. 
56 

TABLE III.2 

AVERAGE CLASSROOM QUALITY SCORES FOR CENTER CARE 

USED BY EARLY HEAD START FAMILIES 

(ALL SITES, WHEN CHILD WAS 14, 24, AND 36 MONTHS OLD) 

Quality Measures 14 Months 24 Months 36 Months 

ITERS/ECERS-R 

 

Averagea 4.7 (1.1) 4.9 (1.1) 5.0 (1.1) 

Rangeb

 1.5 – 6.8 1.6 – 6.8 1.2 – 6.8 

N 274 290 316 

 

Arnett – Full Scale 

Averagea

 3.4 (0.4) 3.4 (0.5) 3.4 (0.5) 

Rangeb

 1.5 – 4.0 1.3 – 4.0 1.3 – 4.0 

N 276 288 311 

 

Child–Adult Ratiosc 

Averagea 2.9 (1.2) 3.5 (1.6) 5.5 (2.6) 

Range 0.8 – 7.7 1.0 – 11.6 0.8 – 14.8 

N 275 291 313 

Source: Based on observations in “eligible” care arrangements, defined as care that occurs for 

at least 10 hours per week outside a child’s home, or by a nonrelative in the child’s 

home. Only one arrangement per child was observed. 

Note: Individual observations were not conducted for all children at 14 months. Children in 

the same locations who were scheduled to be observed within three months of each 

other were assigned the same classroom characteristics. 

a

Standard deviations in parentheses. 

b

The minimum possible average score on the ITERS and ECERS-R is 1.0 and the maximum 

possible is 7.0. The minimum possible average for the Arnett is 1.0 and the maximum is 4.0. 

c

Child-adult ratios were recorded six times during each observation. The average presented here 

is the average of all nonmissing observations. 
57 

Analysis of the ITERS and ECERS-R scale scores shows variation in the levels of quality 

across the dimensions rated. At both 14 and 24 months, centers were rated highest or second 

highest on the ITERS Interactions scale, while several other key dimensions also scored at or 

near the “good” level of 5.0 (Figure III.1). At both ages, Learning Activities received one of the 

lowest ratings (4.2 at 14 months and 4.4 at 24 months). Levels found with the ECERS-R scales 

differ somewhat from those of the ITERS, but the same general pattern was found (Figure III.2). 

The Arnett Caregiver Interaction Scale assesses the quality and content of the teacher’s 

interactions with children in both center and family child care settings. Two studies have found 

that Arnett scale scores predict teachers’ engagement with children and children’s language 

development and security of attachment (Helburn 1995; and Howes, Phillips, and Whitebook 

1992). The quality of caregiver interactions with children, as measured by the Arnett scale, was 

constant across the three ages, at an average rating of 3.4 (Table III.2). The variation in these 

scores across classrooms was also wide, ranging from 1.3 to 4.0.4

Finally, child-adult ratios averaged 2.9 children per adult at 14 months and 3.5 to 1 at 

24 months, meeting the performance standards for infants and toddlers, on average. The ratio at 

36 months rose to 5.5 children per adult.5

 After children turn 3, however, higher ratios might be 

appropriate. Even the 5.5 ratio, however, is lower than ratios found in other studies. For

 4

We know of no standard convention in the literature to indicate the rating on the Arnett that 

is accepted as “good quality,” in the sense that 5.0 on the ITERS, ECERS-R, and FDCRS is. 

However, a rating of 3 out of a possible 4 indicates the statements (such as, “speaks warmly to 

children”) are “quite a bit” characteristic of the primary caregiver. 

5

The Head Start Program Performance Standards specify ratios of 4:1 for children under 

3 years of age. At the 36-month age point in the Early Head Start evaluation, some children 

were observed when they were slightly younger than 36 months, but most were 36 months or 

older. Therefore, some might be subject to the performance standards for 3-year-olds, which 

allow 13 to 15 children for 2 adults. 
5.4

5.1

4.8 4.8 4.6

4.3 4.2

1

2

3

4

5

6

7

Interactions Program

Structure

Personal Care

Routines

Listening and

Talking

Furnishings Adult Needs Learning

Activities

14 Months

Average ITERS Score

Source: Based on outside observations of “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one

arrangement per child was observed.

Note: Individual observations were not conducted for all children at 14 months. Children in the same care

setting who were scheduled to be observed within three months of each other were assigned the same 

classroom characteristics. The possible range on each subscale is 1.0 – 7.0.

AVERAGE ITERS SUBSCALE SCORES FOR CENTER CARE 

USED BY EARLY HEAD START FAMILIES

(ALL SITES, WHEN CHILDREN WERE 14 AND 24 MONTHS OLD)

5.3 5.2 5.1

5.4

5.1

4.2 4.4

1

2

3

4

5

6

7

Interactions Program

Structure

Personal Care

Routines

Listening and

Talking

Furnishings Adult Needs Learning

Activities

24 Months

Average ITERS Score

n = 273 n = 261 n = 274 n = 271 n = 272 n = 195 n = 273

n = 287 n = 274 n = 290 n = 289 n = 290 n = 286 n = 290

58
6.0

5.4 5.3 5.2 5.0 4.9

4.1

1

2

3

4

5

6

7

Parents and

Staff

Program

Structure

Interactions Furnishings Personal Care

Routines

Language and

Reasoning

Activities

Average ECERS Score

Source: Based on outside observations of “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one

arrangement per child was observed.

Note: The possible range on each subscale is 1.0 – 7.0.

FIGURE III.2

AVERAGE ECERS-R SUBSCALE SCORES FOR CENTER CARE 

USED BY EARLY HEAD START FAMILIES

(ALL SITES, WHEN CHILD WAS 36 MONTHS OLD)

n = 289 n = 311 n = 316 n = 317 n = 315 n = 313 n = 315

59
60 

example, the Profile of Child Care Settings Study found an average child-staff ratio of between 

6 to 1 and 7 to 1 in a nationally representative sample of centers (Kisker, Hofferth, Phillips, and 

Farquhar 1991). 

Virtually all family child care (provided by relatives and nonrelatives) used by Early Head 

Start parents was found in community settings, and was not directly provided by the Early Head 

Start programs. Nevertheless, programs were also in the process of establishing partnerships 

with family child care providers throughout the evaluation period, although these partnerships 

were not as prevalent as ones with community centers. The evaluation observed children in 

these family child care settings at the same three age points, using the FDCRS. As with the 

centers, average FDCRS ratings rose slightly over the three time periods, from 3.4 to 3.9, but 

remained below the level of “good” quality, as the instrument developers describe their scale 

(Table III.3). The range of the quality ratings was wide for each time period, between 

1.2 and 6.6. 

Early Head Start children whom we were able to observe in family child care consistently 

experienced caregivers who were rated above 3, on average, on the Arnett Caregiver Interaction 

Scale. The average score was 3.2 or 3.3 for each time period, which is very close to the Arnett 

ratings for center teachers. The variability of Arnett ratings was less for child care homes, 

however: the Arnett quality ratings in family child care homes ranged from 2.0 to 4.0. Childadult ratios averaged 4.0 or lower in all three time periods, thus meeting the Head Start 

performance standards for this measure. 

The FDCRS also allows for analysis of quality by scales, in this case six. Across all three 

age points, the highest ratings of the family child care homes that Early Head Start children 

attended were found in the areas of Adult Needs, Supports for Social Development, and 
61 

TABLE III.3 

AVERAGE QUALITY SCORES FOR FAMILY CHILD CARE 

USED BY EARLY HEAD START FAMILIES 

(ALL SITES, WHEN CHILD WAS 14, 24, AND 36 MONTHS OLD) 

Quality Measures 14 Months 24 Months 36 Months 

FDCRS 

 

Averagea 3.4 (1.0) 3.9 (1.2) 3.9 (1.3) 

Rangeb 1.4 – 5.9 1.3 – 6.6 1.2 – 6.6 

N 67 82 55 

 

Arnett – Full Scale 

Averagea

 3.2 (0.5) 3.3 (0.5) 3.3 (0.4) 

Rangeb

 2.2 – 4.0 2.0 – 4.0 2.1 – 4.0 

N 68 83 53 

 

Child–Adult Ratiosc

 

Averagea 3.2 (2.1) 3.8 (2.2) 4.0 (2.1) 

Range 0.5 – 10.8 0.5 – 11.0 0.3 – 9.5 

N 67 83 54 

Source: Based on observations in “eligible” care arrangements, defined as care that occurs for 

at least 10 hours per week outside a child’s home, or by a nonrelative in the child’s 

home. Only one arrangement per child was observed. 

Note: Individual observations were not conducted for all children at 14 months. Children in 

the same locations who were scheduled to be observed within three months of each 

other were assigned the same classroom characteristics. 

a

Standard deviations in parentheses. 

b

The minimum possible average score on the FDCRS is 1.0 and the maximum possible is 7.0. 

The minimum possible average for the Arnett is 1.0, and the maximum is 4.0. 

c

Child-adult ratios were recorded six times during each observation. The average presented here 

is the average of all nonmissing observations. 
62 

Language and Reasoning; lowest ratings (which were more than 1 point lower than the highest 

scales) were in Furnishings and Basic Care (Figure III.3). 

2. Quality of Child-Caregiver Interactions (as Measured by the C-COS) 

We turn now from measures of global quality to examine child-caregiver interactions as 

indicators of the quality of the child care settings children were in. Four key C-COS variables 

are reported in this paper: (1) any caregiver talk to the child (combining responding to the child 

and initiating verbal interactions with the child)—these include requesting language or 

communication, requesting action, reading to the child, and other talking or singing; 

(2) caregiver responding to the child (including requesting language or communication, 

requesting action, reading to the child, or other talking or singing); (3) caregiver initiating talk 

with the child (same categories as responding); and (4) incidents of children’s negative behavior 

(including wandering, upset/crying, and hitting/biting/bothering another child or being 

hit/bothered by another child). Table III.4 shows average C-COS scores for Early Head Start 

children in center and family child care at 24 and 36 months of age. At 24 months of age, the 

frequency of caregiver talk to children was similar (about 30 incidents) for children in center and 

family child care, while at 36 months of age, caregiver talk was lower in centers. Incidents of 

caregiver talk to 36-month-old children were, in general, slightly lower than to 24-month-old 

children, and somewhat higher in family than center child care. Children in center care 

experienced an average of 26 incidents of any talk, while children in family child care 

experienced an average of 31. 

Incidents of the caregiver responding to the child were much lower than initiations, 

averaging between seven and eight incidents per child in the 2-hour observation period. 

Caregivers showed slightly more responsiveness to 24- than to 36-month-old children, in both 

centers and family child care homes. Children in family child care at 36 months experienced 
4.2

3.9 3.7

3.3 3.1 3.0

1

2

3

4

5

6

7

Adult Needs Social

Development

Language and

Reasoning

Learning Activities Furnishings Basic Care

14 Months

Average FDCRS Score

AVERAGE FDCRS SUBSCALE SCORES FOR FAMILY CHILD CARE 

USED BY EARLY HEAD START FAMILIES

(ALL SITES, WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD)

4.9

4.3

4.0 3.9 3.7 3.5

1

2

3

4

5

6

7

Adult Needs Social

Development

Language and

Reasoning

Learning Activities Furnishings Basic Care

24 Months

Average FDCRS Score

n = 66 n = 66 n = 67 n = 67 n = 66 n = 67

n = 79 n = 81 n = 83 n = 81 n = 83 n = 81

63
4.7

4.1 4.1 3.9 3.9

3.5

1

2

3

4

5

6

7

Adult Needs Social

Development

Language and

Reasoning

Learning Activities Furnishings Basic Care

36 Months

Average FDCRS Score

FIGURE III.3 (continued)

__________________________________________________________________________________________

Source: Based on outside observations of “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a non-relative in the child’s home. Only one

arrangement per child was observed.

Note: Individual observations were not conducted for all children at 14 months. Children in the same care

setting who were scheduled to be observed within three months of each other were assigned the same 

family care characteristics. The possible range on each subscale is 1.0 – 7.0.

n = 53 n = 54 n = 55 n = 55 n = 55 n = 55

64
65 

TABLE III.4 

AVERAGE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) SCORES FOR 

CENTER AND FAMILY CHILD CARE SETTINGS USED BY EARLY HEAD START 

FAMILIES WHEN CHILDREN WERE 24 AND 36 MONTHS OLD 

 Center-Based Care Family Child Care 

C-COS Variable 24 Months 36 Months 24 Months 36 Months

Incidents of Any Caregiver 

Talk to Child 

Averagea 29.7 (12.3) 25.8 (12.5) 30.4 (13.2) 31.3 (15.1)

Range 1 – 60 0 – 60 3 – 60 6 – 60 

N 297 323 90 65 

 

Incidents of Caregiver 

Responding to Child 

Averagea 8.5 (9.0) 7.6 (7.2) 8.1 (10.5) 7.4 (7.7) 

Range 0 – 48 0 – 38 0 – 48 0 – 28 

N 297 323 90 65 

 

Incidents of Caregiver 

Initiating Talk with Child 

Averagea 21.8 (10.8) 18.8 (11.6) 22.6 (11.4) 24.2 (13.5)

Range 0 – 58 0 – 57 0 – 59 1 – 55 

N 297 323 90 65 

 

Incidents of Child Negative 

Behavior 

Averagea

 5.5 (5.8) 4.0 (4.8) 5.4 (5.6) 3.3 (4.4) 

Range 0 – 36 0 – 36 0 – 36 0 – 17 

N 297 323 90 65 

Source: Based on observations “eligible” care arrangements, defined as care that occurs for at 

least 10 hours per week outside a child’s home, or by a nonrelative in the child’s 

home. Only one arrangement per child was observed. 

Note: Based on observations at all sites at 24 and 36 months. Possible range of number of 

incidents is 0 to 60 over a 2-hour observation period. Sample sizes are slightly larger 

than for the ITERS/ECERS and FDCRS due to fewer missing values. 

a

Standard deviations in parentheses. 
66 

24 incidents of caregiver-initiated talk, while 36-month-old children in center care experienced 

about 19 incidents, on average. 

We might expect more verbal interaction between child and caregiver at 36 months because 

children have higher verbal ability, but in general children at that age experienced fewer 

interactions with their caregivers in center settings. This could be due to the rising child-adult 

ratios or to children having more interactions with peers. Perhaps the ratio indicates the fraction 

of the caregiver’s attention that each child in her care can receive within a fixed time period. In 

family child care, however, there were slightly more incidents of any caregiver talk to the child 

at 36 than at 24 months. 

Instances of negative child behavior were observed infrequently. On average, about the 

same number of incidents of negative behavior were observed for 24-month-old children in 

centers and family child care (5.5 and 5.4, respectively, out of a possible 60 across all the 

observation intervals). The range and variance in the number of incidents were also similar in 

the two settings. Older children displayed fewer incidents of negative behavior: 36-month-old 

children in child care centers displayed an average of 4.0 incidents of negative behavior, 

compared with 5.5 incidents for 2-year-olds. Children in family child care experienced 

3.3 incidents at age 3, and 5.4 at age 2. The range and variance in negative behaviors were 

smaller for children in family child care than for children in centers. 

Two important indicators of the quality of child-caregiver interactions at age 3 were 

substantially higher in family child care settings than in center care: (1) incidents of any 

caregiver talk to child at age 3 were 31.3 and 25.8 in family and center care settings, respectively 

(a difference of more than one-third of a standard deviation); and (2) incidents of the caregiver 

initiating talk with the Early Head Start child at age 3 were 24.2 in family care, compared to 

18.8 in center care (also a difference of more than a third of a standard deviation). However, 
67 

since nonresponse was so much higher for family child care than center care, it is likely that the 

center care we observed is more representative of all center care for Early Head Start children 

(both community centers and care provided by Early Head Start) than the family child care we 

observed is for home-based settings more generally. The family child care settings we observed 

are likely to be of higher quality than the in-home care provided by relatives or nonrelatives used 

by all Early Head Start children. 

3. Quality Experienced by Early Head Start Children in Early Head Start and 

Community Centers 

As reported in an earlier section, Early Head Start children experienced good- or nearly 

good-quality care averaged across all forms of center care. We further analyzed the average 

classroom-level quality for children in center care by contrasting the experiences of Early Head 

Start children in Early Head Start centers and Early Head Start children in community-based 

centers. The same measures were used—ITERS and ECERS-R, Arnett caregiver ratings, and 

child-adult ratios—when children were 14, 24, and 36 months old, and the sample includes all 

children whom we observed in center care across all sites. ITERS and ECERS-R scores were 

consistently higher, on average, for children in Early Head Start centers (Figure III.4). The 

average of these global quality ratings was consistently good in Early Head Start centers, ranging 

between 5.0 and 5.2 across the three time periods. 

The largest disparity between Early Head Start and community centers appeared at 

14 months, when average ITERS quality in Early Head Start centers was 5.0 and just 3.8 in 

community centers. The disparity narrowed by 36 months due to the improving scores for 

community centers—by 36 months of age, only 0.2 points on the ECERS-R separated the quality 

levels of Early Head Start and community child care centers (Figure III.4). 
5.0

5.2 5.1

3.8

4.5

4.9

7654321

14 Months*** 24 Months*** 36 Months

Mean Quality Rating Early Head Start Centers Community Centers

FIGURE III.4

AVERAGE ITERS AND ECERS-R QUALITY RATINGS FOR EARLY HEAD START AND

COMMUNITY CENTERS WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

SOURCE: Based on observations of “eligible” care arrangements, defined as care that occurs for at least 10 hours per week 

outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: Individual observations were not conducted for all children at 14 months. Children in the same care setting who 

were scheduled to be observed within three months of each other were assigned the same classroom characteristics.

***Difference is statistically significant at the 

01 level

n = 214 n = 60 n = 196 n = 94 n = 120 n = 196

ITERS Rating ITERS Rating ECERS-R Rating

6

8
69 

Differences also appeared in the ITERS and ECERS-R subscales. For every subscale at 

every age (except for Program Structure and Language and Reasoning at 36 months), the Early 

Head Start-community setting differences were statistically significant (Figure III.5).

The differences between Early Head Start and community settings on the Arnett scale were 

less dramatic but followed the same pattern, and only the difference at 14 months was significant 

(Figure III.6). Average Arnett ratings at Early Head Start centers across all three time periods 

were between 3.4 and 3.5. Between 14 and 36 months of age, average quality in community 

centers by this measure increased from 3.1 to 3.4, so that by the time children were 2 and 3 years 

old there was little difference between Early Head Start and community centers. 

In another indication of the good quality provided by Early Head Start programs, child-adult 

ratios were consistently lower (that is, fewer children per adult) in Early Head Start than 

community child care centers (Figure III.7). Average child-adult ratios were 2.6 to 1 for Early 

Head Start centers enrolling 14-month-old children and 3.0 to 1 for Early Head Start 24-monthold children. Average ratios increased from 2.6 to 1 to 4.5 to 1 in Early Head Start centers 

between 14 and 36 months of age. In community centers, ratios increased from 3.9 to 1 when 

children were 14 months old to 6.1 children per adult at 36 months. As noted earlier, by 

36 months, many Early Head Start children had left the program and were likely to have been in 

preschool classrooms where higher ratios are acceptable. 

Considering specific caregiver and child behaviors and interactions as quality indicators, 

Figure III.8 shows the average number of incidents of three caregiver interaction behaviors and 

one child behavior coded on the C-COS when children were 24 and 36 months old. The patterns 

of better quality in Early Head Start than community centers seen with the global measures 

appear here also, but the differences are less pronounced. Children in Early Head Start centers 

experienced higher levels of any caregiver talk than children at community centers at 36 months, 
5.8

5.4

5.1 5.1

4.8

4.6 4.4 4.4

4.2

3.9 3.8 4.0

3.5

3.3

1

2

3

4

5

6

7

Average ITERS Score

AVERAGE ITERS AND ECERS-R SUBSCALE SCORES FOR

EARLY HEAD START AND COMMUNITY CENTERS

(ALL SITES, WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD)

5.5 5.4 5.4 5.6

5.2

4.5 4.5

4.9 4.9

4.6

4.9 4.7

3.5

4.2

1

2

3

4

5

6

7

Average ITERS Score

n=214 n=59 n=205 n=36 n=214 n=60 n=212 n=59 n=212 n=60 n=145 n=50 n=214 n=59

n=194 n= 93 n=184 n= 90 n=196 n=94 n=195 n=94 n=196 n=94 n=192 n=94 n=196 n=94

70

Interactions*** Program 

Structure***

Personal Care 

Routines***

Listening and 

Talking***

Furnishings*** Adult 

Needs***

Learning 

Activities***

Interactions*** Program 

Structure***

Personal Care 

Routines***

Listening and 

Talking***

Furnishings*** Adult 

Needs**

Learning 

Activities**

Early Head Start Centers Community Centers

14 Months

24 Months
6.3

5.5 5.6 5.4 5.3

4.9

4.0

5.8

5.3 5.1 5.1 4.9 4.9

4.2

1

2

3

4

5

6

7

Average ECERS-R Score

FIGURE III.5 (continued)

__________________________________________________________________________________________

Source: Based on outside observations of “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a non-relative in the child’s home. Only one

arrangement per child was observed.

Note: Individual observations were not conducted for all children at 14 months. Children in the same care

setting who were scheduled to be observed within three months of each other were assigned the same 

classroom characteristics. The possible range on each subscale is 1.0 – 7.0.

**Difference is significant at the .05 level.

***Difference is significant at the .01 level.

n=109 n=180 n=115 n=196 n=120 n=196 n=121 n=196 n=120 n=195 n=118 n=195 n=120 n=195

71

Parents and

Staff***

Program 

Structure

Personal Care 

Routines***

Furnishings** Language and 

Reasoning

Interactions*** Activities**

Early Head Start Centers Community Centers

36 Months
3.5

3.4

3.5

3.1

3.3

3.4

4321

14 Months*** 24 Months 36 Months

Mean Arnett Rating Early Head Start Centers Community Centers

FIGURE III.6

AVERAGE CAREGIVER ARNETT SCORES FOR EARLY HEAD START AND COMMUNITY CENTERS 

WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

n = 216 n = 60 n = 195 n = 93 n = 118 n = 193

SOURCE: Based on observations of “eligible” care arrangements, defined as care that occurs for at least 10 hours per week 

outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: Individual observations were not conducted for all children at 14 months. Children in the same care setting who 

were scheduled to be observed within three months of each other were assigned the same classroom characteristics.

***Difference is statistically significant at the 

01 level

7

2
2.6

3.0

4.5

3.9

4.4

6.1

7654321

Mean RatioEarly Head Start Centers Community Centers

FIGURE III.7

AVERAGE CHILD-ADULT RATIOS FOR EARLY HEAD START AND COMMUNITY CENTERS

WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

n = 216 n = 59 n = 197 n = 94 n = 120 n = 193

SOURCE: Based on observations of “eligible” care arrangements, defined as care that occurs for at least 10 hours per week 

outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: Individual observations were not conducted for all children at 14 months. Children in the same care setting who 

were scheduled to be observed within three months of each other were assigned the same classroom characteristics.

14 Months*** 14 Months*** 36 Months***

7

3
FIGURE III.8

AVERAGE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) SCORES FOR EARLY HEAD 

START AND COMMUNITY CENTERS WHEN CHILDREN WERE 24 AND 36 MONTHS OLD

27.7 29.2

24.5

30.0

50

3025201510

24 Months 36 Months**

Incidents of Any Caregiver Talk

Number of Incidents22.3 22.3 20.6 17.6

50

3025201510

24 Months 36 Months**

Incidents of Caregiver Initiating Talk

Number of Incidents

SOURCE: Based on observations in “eligible” care arrangements, defined as those that occur for at least 10 hours per week outside a child’s home, 

or by a non-relative in the child’s home. Only one arrangement per child was observed.

NOTE: The possible range for the number of incidents of negative behavior and caregiver talk is 0-60 over a 2-hour observation period.

n = 201 n = 96 n = 123 n = 200

n = 210 n = 96 n = 123 n = 200

n = 201 n = 96 n = 123 n = 200

n = 201 n = 96 n = 123 n = 200

8.2 7.6 9.0 7.6

50

3025201510

24 Months 36 Months

Incidents of Caregiver Responding to Child

Number of Incidents

5.5 4.5 5.6 3.6 5

0

3025201510

24 Months 36 Months

Incidents of Child Negative Behavior

Number of Incidents

Early Head Start Center Community Center

(a) (b)

(c) (d) 7

4
75 

28 versus 25 incidents of talk (Figure III.8a). This difference is driven by the difference in talk 

initiated by the caregiver (Figure III.8b), with Early Head Start children experiencing an average 

of about 22 incidents and children in community centers just under 18. When they were 2 years 

old, children across the two settings did not experience differential amounts of caregiver talk. 

The small differences between the number of incidents of children’s negative behavior in Early 

Head Start and community centers were not significant at either 24 or 36 months of age (Figures 

III.8c and III.8d). 

In this section, we have seen multiple measures of program quality that almost unanimously 

demonstrate that Early Head Start children experienced higher levels of quality in centers 

operated by Early Head Start programs when compared with community-based centers, and 

higher quality in centers than in family child care settings, although we compare centers and 

family care cautiously because of small samples of the latter and the potential for bias in which 

family care settings were observed. C-COS data suggested that Early Head Start children in 

family child care experienced somewhat more caregiver talk than children in center care, in 

contrast to the global quality differences between the two modes of care. Quality in community 

settings, however, apparently improved somewhat as children got older. The older children 

became, the less difference there was in the quality of care received in Early Head Start-operated 

and community-based child care centers. This may be due to the efforts that Early Head Start 

programs expended to improve quality among community partners, or to the fact that 

environmental ratings are generally higher for preschoolers than for infants (Cost, Quality, and 

Child Outcomes Study Team 1995). 

C. SUMMARY OF EARLY HEAD START QUALITY OF CHILD CARE 

Considering several measures of quality, we find that Early Head Start children generally 

experienced good quality—quality that meets the Head Start Program Performance Standards—
76 

in the child care centers they were enrolled in. On standard, widely used global measures, the 

quality of care appeared somewhat lower in family child care than in center arrangements. 

However, when compared using a measure of specific caregiver-child interactions, we found 

evidence that family care arrangements may provide advantages for children in terms of the 

amount of caregiver verbal interactions with the Early Head Start child. However, given the 

small percentage of family care arrangements we were able to observe, it is difficult to draw 

conclusions about the quality of family care experienced by the full sample of Early Head Start 

children. Community centers used by Early Head Start families were generally of lower quality 

than the Early Head Start centers, but their quality ratings improved over time so that by the time 

Early Head Start families were placing their 3-year-olds in community centers, their quality was 

very close to that of Early Head Start centers. 

D. EARLY HEAD START PROGRAMS’ IMPACTS ON CHILD CARE QUALITY 

We now come to one of the central questions about the role of Early Head Start programs in 

providing child care opportunities for low-income families with infants and toddlers: was the 

program effective in ensuring that its children were in child care settings of higher quality than 

available to the families who had been randomly assigned to the control group. First, we 

examine the extent to which families’ participation in an Early Head Start program increased 

their likelihood of using higher-quality child care. This analysis is followed by a second set of 

analyses in which we show how Early Head Start programs made a difference in the levels of 

quality in the child care arrangements in which they placed their children. In short, this section 

reports findings related to whether Early Head Start programs accomplished what they set out to 

do—to improve the chances for children to experience good-quality child care. 
77 

1. Approach to the Analyses of Impacts on Child Care Quality 

Sample Limitations. As described in Chapter I, observations of quality in child care settings 

were completed for a subsample of the families who reported using child care. Not all families 

used child care, nor were we able to observe all those who did. The sample used for analysis of 

the impact of Early Head Start programs on child care quality includes all four center-based sites, 

four mixed-approach sites in all three time periods, and one additional site for the mixedapproach analysis at 36 months.6

 Since we were not able to observe quality in most home-based 

or family child care arrangements, we did not conduct analyses of the programs’ impact on the 

quality of family child care used by Early Head Start children. Nevertheless, we were able to 

address a significant part of the question the Advisory Committee posed regarding Early Head 

Start increasing the probability that children would receive quality child care. The analyses 

reported provide clear answers to the question: Do Early Head Start programs increase the 

probability that children will receive good-quality center care?7

Analytic Issues. Child care quality could be assessed only if families were using child care. 

It seems likely that the families who were using child care differed in important characteristics 

from those families who were not using child care. Furthermore, it is possible that the factors 

affecting which families placed their children in child care were different depending on whether 

 6

As reported in the Early Head Start implementation study (ACF 2002c), designation of 

programs as mixed-approach indicated that they provided some combination of center- and 

home-based services. Based on the 1997 site visits, seven programs were designated as mixedapproach; four of these had sufficient samples of center observations to be included in the impact 

analyses. One additional mixed-approach program subsequently added a center and had a large 

enough observation sample to allow us to add a fifth site to our analyses during the period in 

which the 36-month observations were conducted. 

7

Even though the analyses we conducted to address this question were based on a subset of 

the research sites, the sites included in the impact analyses represent between 75 and 85 percent 

of all center care that children in our sample experienced. 
78 

the family was in the program or control group. Therefore, because of the potential for bias, it 

would not be appropriate simply to compare program and control-group quality for those 

children who were in child care. We already know, as presented in Chapter II, that program 

families were more likely to use center care, so it is possible that characteristics of families in the 

two groups differ, and are themselves correlated with the quality of the centers used.8

 Additional 

biases could have been introduced because we were not able to complete observations in all 

eligible settings, and we do not know the extent to which the centers observed are representative 

of all centers that could have been observed. It is possible, for example, that the centers that 

allowed our observers in were of higher quality than those who refused to be observed. To 

minimize these selection-bias concerns, we conducted the impact analysis in two stages. 

Stage 1 Analysis. To avoid the selection bias issue for this research question we conducted 

the first stage analysis that included all Early Head Start and control-group families for whom 

we had complete 14-, 24-, or 36-month Parent Interviews at these sites. (Data presented in the 

evaluation’s final report demonstrated that attrition of parent interview respondents in the full 

sample did not produce any bias affecting the impact analyses [ACF 2002b].) To do this, we had 

to find a child care quality variable that would enable us to include every family in the sample. 

We created a dichotomous variable equal to 1 if the child was in a good-quality child care center, 

 8

Appendix Tables A.4 and A.5 show the baseline characteristics of program and control 

families at the sites where we conducted the impact analyses. The groups differ on a small 

number of demographic characteristics but are highly similar. Nevertheless, unmeasured 

differences due to selection factors are still possible (Duncan, Magnuson, and Ludwig in press). 

These factors relate to at least three different circumstances: (1) family characteristics, such as 

the need for and motivation to seek child care for their child; (2) child care setting 

characteristics, such as the provider’s willingness to allow observers into the center or home, and 

their stability, as some settings were no longer operating when observers arrived; and (3) the 

researchers’ ability to complete the observations within a reasonable time following the birthdayrelated interview.
79 

and 0 if in a lower-quality center or not in child care at all. Children whose classroom received a 

rating of 5.0 or above on the ITERS (at 14 and 24 months of age) or the ECERS-R (at 

36 months) at the time of the observation received a score of 1; if not, they were given a zero.9

 

Similar cutoffs were set for child-adult ratios and the C-COS variables (which are described 

when the findings for each of those instruments are described). Results are presented as the 

difference between the percentage of children in the program and control groups who 

experienced good-quality care. We recognize that the impact estimates from Stage 1 represent 

the joint effects of impacts on the use of any center child care and impacts on the use of goodquality center care among those who used care (and for whom observations were completed). 

Additional analyses were needed to begin to address the question of differential levels of quality 

in the program and control groups. 

Stage 2 Analysis. In the second stage we examined differences between the program and 

control groups in the levels of quality among those families who used center care. Although the 

differences in quality levels cannot be considered true program impacts (because they are based 

on potentially nonrandom subsets of the program and control groups), the results are indicative 

of differences in quality of Early Head Start centers and the centers that were available to 

control-group children in the community. 

 9

All families in the four center-based sites and four mixed-approach sites who completed a 

14- or 24-month Parent Interview—and all families in the four center-based and five mixedapproach sites who completed the 36-month Parent Interview—are included in the analysis. 

Thus, these analyses provide estimates of the impacts for eligible applicants. For those children 

who were in an eligible child care setting but not observed, we imputed the mean value of 

receiving good-quality care among the children in that group (by program approach and 

program-control status) who were observed. In essence, this procedure assumes that the 

percentage of good-quality care settings was the same in the eligible settings we did not observe 

as in the settings we did observe. 
80 

2. Early Head Start’s Impact on the Percentage of Families in Good-Quality Center 

Child Care—Global Measures 

Our first analysis examined impacts across the eight sites at 14 and 24 months and nine sites 

at 36 months for which we had sufficiently large samples sizes and response rates; these include 

both center-based and mixed-approach program sites. At all three ages, Early Head Start had a 

large impact on the percentage of children who were in good quality center care at least 10 hours 

a week (Figure III.9). At 14 and 24 months of age, Early Head Start children were almost three 

times as likely to experience good quality (ITERS > 5.0) center child care as the control children 

(23 percent versus 8 percent at 14 months; 34 versus 12 percent at 24 months). The programcontrol difference narrowed slightly at 36 months, but more than 33 percent of Early Head Start 

children were in good-quality care when they were about 36 months old (> 5.0 on the 

ECERS-R), a percentage that was significantly greater than the 21 percent of control-group 

children. 

Early Head Start impacts on the percentage of children in good-quality centers were greater 

within the sites at which the programs were center-based and somewhat smaller within the 

mixed-approach sites (Figures III.10 and III.11). At the four center-based sites, the percentage in 

good quality ranged from 26 to 37 percent of the sample, whereas only 9 to 16 percent of 

control-group children were in care that scored this high, a statistically significant difference at 

each age level. The large impact on the percentage in quality center care at mixed-approach sites 

was significant at 14 and 24 months, but only marginally significant at age 3 (31 versus 

24 percent; Figure III.11). 

The Early Head Start program’s impact on the percentage of children in centers with childadult ratios that met the performance standards was dramatic. At the four center-based sites at 

14 months of age, Early Head Start children were more than twice as likely as control children 

(72 versus 29 percent) to be in classrooms with ratios of 4 to 1 or better (Figure III.12). At 
23

34 33

8

12

21

0

7560453015

Percent of Sample Program Group Control Group

FIGURE III.9

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN IN GOOD-QUALITY, 

CENTER CARE, WHEN THEY WERE 14, 24, AND 36 MONTHS OLD

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 10 

hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: High quality is defined as 5.0 or higher on the ITERS and ECERS-R. The sample includes all children at four center-based and four mixedapproach sites at all three time periods and an additional mixed-approach site at 36 months. Children in the same location at 14 months scheduled 

to be observed within three months of each other were assigned the same classroom characteristics. The probability of a high ITERS or ECERS-R score was imputed for children in care but not observed.

n = 533 n = 512 n = 505 n = 474 n = 573 n = 521

ITERS ITERS ECERS-R

14 Months*** 24 Months*** 36 Months***

8

1
26

37 35

9

12

16

0

7560453015

Percent of Sample Program Group Control Group

FIGURE III.10

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN IN GOOD-QUALITY, CENTER CARE, 

AT CENTER-BASED SITES WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

n = 268 n = 252 n = 256 n = 224 n = 254 n = 211

ITERS ITERS ECERS-R

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 10 

hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: High quality is defined as 5.0 or higher on the ITERS and ECERS-R. The sample includes all children at four center-based sites at all three time 

periods. Children in the same location at 14 months scheduled to be observed within three months of each other were assigned the same 

classroom characteristics

The probability of a high ITERS or ECERS-R score was imputed for children in care but not observed

14 Months*** 24 Months*** 36 Months***

8

2
19

32 31

7

13

24

0

7560453015

Percent of Sample Program Group Control Group

FIGURE III.11

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN IN GOOD-QUALITY, CENTER CARE, 

AT SELECTED MIXED-APPROACH SITES WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 10 

hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: High quality is defined as 5.0 or higher on the ITERS and ECERS-R. The sample includes all children at the four mixed-approach sites at all 

three time periods and an additional site at 36 months. Children in the same location at 14 months scheduled to be observed within three months of each other were assigned the same classroom characteristics. The probability of a high ITERS or ECERS-R score was imputed for 

children in care but not observed.

n = 265 n = 260 n = 249 n = 250 n = 319 n = 310

14 Months*** 24 Months*** 36 Months*

ITERS ITERS ECERS-R

8

3
72

62

28 29

15

7

0

7560453015

Percent of Sample Program Group Control Group

FIGURE III.12

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN IN CENTER CARE THAT MEETS THE HEAD START 

PROGRAM PERFORMANCE STANDARDS FOR CHILD-ADULT RATIOS, AT CENTER-BASED SITES 

WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 10 

hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: Child-adult ratios of 4.0 or lower meet Head Start Program Performance Standards for infants and toddlers. We use the same ratio for 36-months, 

although higher ratios meet the performance standard for children older than 36 months. The sample includes all children at the four center-based sites. Children in the same location at 14 months scheduled to be observed within three months of each other were assigned the same classroom 

characteristics. The probability of a child-adult ratio of 4.0 or lower was imputed for children in care but not observed.

n = 268 n = 252 n = 256 n = 224 n = 254 n = 211

14 Months*** 24 Months*** 36 Months***

8

4
85 

24 and 36 months, four times as many Early Head Start as control children were in such 

classrooms. The impacts are somewhat less within the mixed-approach programs, but still 

demonstrate very substantial impacts that the program had on the percentage of families whose 

children are in good-quality center child care at all three ages (Figure III.13). 

3. Early Head Start’s Impact on the Percentage of Families in Good-Quality Center 

Child Care—Child-Caregiver Interactions (C-COS Scores) 

Because no established literature is available for setting “good quality” cutoff scores for the 

C-COS observations, we used scores that represent approximately the top quarter of the 

distribution of scores as a cutoff for the Stage 1 impact analyses. We set the cutoff for any talk 

at 34 incidents, for caregiver responding at 11 incidents, and for caregiver initiated talk at 

28 incidents. 

Early Head Start programs in center-based sites had a large and significant impact on total 

caregiver talk with child (Figure III.14a), caregiver responsiveness to child (Figure III.14b), and 

the caregiver’s initiation of talk (Figure III.14c) at both 24 and 36 months of age. For example, 

when children were 2 years old, 43 percent of Early Head Start children experienced caregiver 

talk above the cutoff (34 or more incidents), compared to only 19 percent of control-group 

children at the center-based sites. The impacts at 24 months were consistently larger and more 

robust than when children were 36 months old. The percentage of Early Head Start children 

experiencing a high level of any caregiver talk dropped to 26 percent at 36 months, while the 

percentage of control-group children stayed about the same (20 percent). Early Head Start had 

no impact on incidents of negative behavior; but, as we saw earlier (Figure III.8), very few 

negative behaviors were observed overall. 

In the centers operated by the mixed-approach sites included in this analysis, Early Head 

Start programs’ impact on child-caregiver interactions were smaller but followed a similar
39

36

20

18

9

4

0

7560453015

Percent of Sample Program Group Control Group

FIGURE III.13

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN IN CENTER CARE THAT MEETS THE HEAD START 

PROGRAM PERFORMANCE STANDARDS FOR CHILD-ADULT RATIOS, AT SELECTED MIXED-APPROACH SITES 

WHEN CHILDREN WERE 14, 24, AND 36 MONTHS OLD

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 10 

hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

NOTE: Child-adult ratios of 4.0 or lower meet Head Start Program Performance Standards for infants and toddlers. We use the same ratio for 36-months, 

although higher ratios meet the performance standard for children older than 36 months. The sample includes all children at four mixed-approach 

sites at all three time periods and an additional site at 36 months. Children in the same location at 14 months scheduled to be observed within three 

months of each other were assigned the same classroom characteristics. The probability of a child-adult ratio of 4.0 or lower was imputed for children in care but not observed

n = 265 n = 260 n = 250 n = 249 n = 319 n = 310 

14 Months*** 24 Months*** 36 Months***

8

6
FIGURE III.14

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN EXPERIENCING HIGH LEVELS OF CAREGIVER TALK

IN CENTER CARE AT CENTER-BASED SITES WHEN CHILDREN WERE 24 AND 36 MONTHS OLD

43

26

19 20

0

453015

Percent of Sample 20 16

8

11

0

453015

Percent of Sample

40

23

17

22

0

453015

Percent of Sample Program Group Control Group

* Difference is statistically significant at the .10 level. 

** Difference is statistically significant at the .05 level.

***Difference is statistically significant at the .01 level.

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

(a) (b)

(c) At Least 34 Incidents of Any Caregiver Talk At Least 11 Incidents of Caregiver Responding to Child

24 Months*** 36 Months** 24 Months*** 36 Months**

n = 256 n = 224 n = 254 n = 211 n = 256 n = 224 n = 254 n = 211

24 Months*** 36 Months**

n = 256 n = 224 n = 254 n = 211

At Least 28 Incidents of Caregiver Initiating Talk with Child

8

7
88 

pattern with two exceptions (Figure III.15). At 36 months of age, the percentage of Early Head 

Start children experiencing high levels of any caregiver talk (12 versus 14 percent) and high 

levels of caregiver initiating talk with the child (8 versus 12 percent) was lower than that for the 

control group. Still, at age 2, the percentage of Early Head Start children who were in 

arrangements with caregivers who displayed high levels of any talking was more than twice as 

great as that for control children (28 versus 11 percent). Similarly, 2-year-old Early Head Start 

children experienced three times as much caregiver responsiveness in their classrooms as their 

control-group counterparts; and the program-control difference at 36 months, though smaller, 

was still significant. 

4. Summary of Program Impacts on Percentages of Children Receiving Good-Quality 

Center Child Care 

Because of their participation in a center-based or mixed-approach Early Head Start 

program, infants and toddlers in low-income families that we studied experienced significantly 

higher-quality center child care. These analyses of the impacts of Early Head Start on the 

percentages of children experiencing good-quality care show strong effects of the program. This 

is true for all measures of quality used—structural and process quality, and both global quality 

and specific caregiver-child interaction measures. Impacts were particularly strong for families 

enrolled in the four center-based programs. 

5. Differences in the Average Quality of Care for Children Observed in Care 

Because of the strong impacts on the percentage of children receiving good-quality care, the 

quality data can also be used to understand the impacts by analyzing the relationship between 

program participation and the levels of quality. This second stage in our analysis is not a pure 

impact analysis due to the selection factors described earlier. However, because we know that 

Early Head Start has strong impacts for the full sample, if we also find differences in levels of 
FIGURE III.15

IMPACT OF EARLY HEAD START ON PERCENTAGE OF CHILDREN EXPERIENCING HIGH LEVELS OF CAREGIVER TALK

IN CENTER CARE AT MIXED-APPROACH SITES WHEN CHILDREN WERE 24 AND 36 MONTHS OLD

28

12 11

14

0

453015

Percent of Sample 23 18

7

14

0

453015

Percent of Sample

21

8

12 13

0

453015

Percent of Sample Program Group Control Group

* Difference is statistically significant at the .10 level. 

** Difference is statistically significant at the .05 level.

***Difference is statistically significant at the .01 level.

SOURCE: Based on responses to Parent Interviews and observations on children in “eligible” care arrangements, defined as care that occurs for at least 

10 hours per week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed.

(a) (b)

(c) At Least 34 Incidents of Any Caregiver Talk At Least 11 Incidents of Caregiver Responding to Child

24 Months*** 36 Months** 24 Months*** 36 Months**

n = 249 n = 250 n = 319 n = 310 n = 249 n = 250 n = 319 n = 310

24 Months*** 36 Months**At Least 28 Incidents of Caregiver Initiating Talk with Child

n = 249 n = 250 n = 319 n = 310

8

9
90 

quality when including only those we observed in the analysis, we are in a stronger position to 

argue that it was participation in the Early Head Start program that is responsible for the 

program-control differences in observed quality. 

Tables III.5 and III.6 show the average classroom quality scores (ITERS, ECERS-R, Arnett, 

and child-adult ratios) experienced by Early Head Start program and control-group children at 

sites included in the impact analyses. Classroom quality scores, measured by the ITERS and 

ECERS-R, were consistently higher for Early Head Start than the control group at center-based 

sites. Average ITERS/ECERS-R ratings ranged from 4.7 to 4.9 for Early Head Start children. 

Scores for control-group children rose slightly over time, from an average of 3.9 to 4.1, but were 

always substantially lower than those experienced by Early Head Start children at all three time 

periods. The program-control differences represent effect sizes of about .7, .9, and .5 at the three 

ages. Classroom caregiver quality, as measured by the Arnett scale, was also higher for Early 

Head Start program children, with ratings of 3.4 and 3.3, which are consistently higher than the 

3.0 to 3.2 ratings experienced by control-group children. Child-adult average ratios were also 

consistently lower (more favorable) for Early Head Start children than control children at the 

four center-based sites. Early Head Start ratios averaged a low of 2.8 to 1 for 14-month-old 

children and rose to 5.6 to 1 by 36 months. The ratio for control-group children was 3.9 to 1 at 

14 months and rose to 6.8 to 1 by 36 months of age. 

Quality was also higher in the classrooms attended by Early Head Start children than control 

children at the mixed-approach sites (Table III.6). The program-control differences in the 

ITERS/ECERS-R ratings were not quite as dramatic as in the center-based sites, however. The 

largest difference occurred at 14 months of age, when Early Head Start children experienced an 

average of 4.7, while control children experienced classrooms rated at 3.7. The difference at 

36 months was no longer statistically significant. Program-control differences in classroom 
91 

TABLE III.5 

AVERAGE QUALITY SCORES OF CHILD CARE CENTERS USED BY EARLY HEAD START AND 

CONTROL CHILDREN AT CENTER-BASED SITES 

14 Months 24 Months 36 Months 

Quality Measure Program Control Program Control Program Control 

ITERS/ECERS-R 

Average (S.D.) 4.8 (1.0) 3.9 (1.3)*** 

 

4.9 (1.0) 3.8 (1.2)*** 

 

4.7 (1.0) 4.1 (1.3)*** 

Range 1.9 – 6.8 1.8 – 6.5 1.7 – 6.6 1.9 – 6.3 1.2 – 6.8 1.1 – 6.9 

N 168 52 162 48 153 72 

 

Arnett 

Average (S.D.) 3.4 (0.3) 3.1 (0.5)*** 3.3 (0.4) 3.0 (0.6)*** 3.3 (0.5) 3.2 (0.6)** 

Range 2.4 – 4.0 1.5 – 3.9 2.0 – 4.0 1.8 – 3.8 1.3 – 3.9 1.8 – 3.9 

N 171 50 161 47 150 72 

 

Child-Adult Ratios 

Average (S.D.) 2.8 (1.0) 3.9 (1.7)*** 3.2 (1.1) 5.5 (2.6)*** 5.6 (3.0) 6.8 (2.7)*** 

Range 1.0 – 6.8 1.0 – 7.4 1.0 – 8.8 1.0 – 14.0 1.7 – 14.8 1.0 – 14.5 

N 162 45 159 47 152 72 

Source: Based on observations of “eligible” care arrangements, defined as care that occurs for at least 10 hours per week 

outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was observed. 

Note: Based on observations at the four center-based sites at all three time periods. Individual observations were not 

conducted for all children at 14 months. Children in the same locations who were scheduled to be observed within 

three months of each other were assigned the same classroom characteristics. 

 ** Program-control difference is statistically significant at the .05 level. 

*** Program-control difference is statistically significant at the .01 level. 
92 

TABLE III.6 

AVERAGE QUALITY SCORES OF CHILD CARE CENTERS USED BY EARLY HEAD START AND 

CONTROL CHILDREN AT MIXED-APPROACH SITES 

14 Months 24 Months 36 Months 

Quality Measure Program Control Program Control Program Control 

ITERS/ECERS-R 

Average (S.D.) 4.7 (1.2) 3.7 (1.2)*** 4.9 (1.3) 4.3 (1.3)** 5.0 (1.1) 4.7 (1.2) 

Range 1.5 – 6.6 1.9 – 6.4 1.6 – 6.7 2.3 – 6.4 2.3 – 6.7 1.6 – 6.9 

N 63 26 67 34 93 72 

Arnett 

Average (S.D.) 3.4 (0.5) 3.0 (0.7)*** 3.4 (0.7) 3.4 (0.5) 3.5 (0.5) 3.4 (0.4) 

Range 1.5 – 4.0 1.4 – 3.9 1.3 – 4.0 2.0 – 4.0 1.7 – 4.0 2.0 – 4.0 

N 63 26 67 34 90 72 

 

Child-Adult Ratios 

Average (S.D.) 2.8 (1.6) 4.4 (1.7)*** 3.8 (2.0) 5.7 (2.0)*** 5.1 (2.3) 7.3 (2.8)*** 

Range 0.8 – 7.7 1.0 – 8.7 1.1 – 10.3 1.7 – 11.2 0.8 – 11.4 2.6 – 13.8 

N 63 26 67 34 89 72 

Source: Based on observations of “eligible” care arrangements, defined as care that occurs for at least 10 hours per 

week outside a child’s home, or by a nonrelative in the child’s home. Only one arrangement per child was 

observed. 

Note: Based on observations at four mixed-approach sites at all three time periods and one additional site at 36 

months. Individual observations were not conducted for all children at 14 months. Children in the same 

locations who were scheduled to be observed within three months of each other were assigned the same 

classroom characteristics. 

 **Program-control difference is statistically significant at the .05 level. 

***Program-control difference is statistically significant at the .01 level. 
93 

caregiver Arnett ratings were also less pronounced than at the center-based sites. The only 

statistically significant difference occurred at 14 months, when Early Head Start children 

experienced higher average quality. Differences in child-adult ratios were somewhat larger at 

the mixed-approach sites. Early Head Start children experienced ratios of 2.8 to 1, on average, 

when they were 14 months old, compared to 4.4 to 1 for control-group children. A large 

difference persisted through to 36 months, when Early Head Start children experienced an 

average ratio of 5.1 to 1 compared to 7.3 to 1 for control-group children. 

Tables III.7 and III.8 show C-COS scores for incidents of caregiver talk and negative child 

behavior. Although fewer program-control differences were significant than we saw with the 

global quality measures, almost all the differences are in the expected direction. Program 

children at the four center-based sites experienced more incidents of any caregiver talk (33.4) 

and caregiver responding to the child (8.1) than control-group children (30.6 and 5.9) when they 

were 24 months old. The same pattern was found at the four mixed-approach sites at 24 months, 

but the program-control differences were a bit larger, and more were statistically significant 

(Table III.8). Early Head Start program children experienced an average of 33.8 incidents of any 

caregiver talk, while control-group children experienced 27.6 incidents. Similarly, Early Head 

Start caregivers in the mixed-approach sites responded to the focus child 11.9 times, compared 

with 6.4 incidents of caregiver responding in the control group. None of the program-control 

differences in the child-caregiver interaction variables was significant when the children were 

3 years old in either center-based or mixed-approach sites. 

6. Summary of Program-Control Differences in Quality of Center Care Received 

Because of the study’s experimental design and the analytic approach taken, we can 

conclude that it is highly likely that the center-based and mixed-approach Early Head Start 

programs included in this analysis succeeded in ensuring that their children received significantly 
94 

TABLE III.7 

AVERAGE NUMBER OF INCIDENTS OF CAREGIVER AND CHILD BEHAVIORS 

CODED BY THE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) 

IN CHILD CARE CENTERS AT CENTER-BASED SITES

24 Months 36 Months 

 Program Control Program Control 

Incidents of Any 

Caregiver Talk 34.4 (12.4) 30.6 (13.3)** 30.2 (12.4) 27.8 (14.4) 

Range 10 – 60 9 – 60 5 – 59 0 – 60 

N 161 58 154 79 

 

Incidents of Caregiver 

Responding to Child 8.1 (8.8) 5.9 (7.2)* 6.9 (5.9) 6.7 (5.7) 

Range 0 – 48 0 – 30 0 – 28 0 – 23 

N 161 58 154 79 

 

Incidents of Caregiver 

Initiating Talk with Child 27.0 (11.9) 25.3 (13.6) 23.8 (11.4) 21.4 (13.9) 

Range 0 – 55 0 – 59 3 – 57 0 – 55 

N 161 58 154 79 

Incidents of Negative 

Behavior 5.7 (5.7) 5.1 (6.0) 4.4 (4.5) 4.5 (4.3) 

Range 0 – 32 0 – 35 0 – 28 0 – 23 

N 161 58 154 79 

Source: Based on observations of “eligible” care arrangements, defined as care that occurs for 

at least 10 hours per week outside a child’s home, or by a nonrelative in the child’s 

home. Only one arrangement per child was observed. 

Note: Based on observations at the four center-based sites at 24 and 36 months. Possible 

range of the number of incidents is 0 to 60 over a 2-hour observation period. 

 *Program-control difference is statistically significant at the .10 level.

**Program-control difference is statistically significant at the .05 level. 
95 

TABLE III.8 

AVERAGE NUMBER OF INCIDENTS OF CAREGIVER AND CHILD BEHAVIORS 

CODED BY THE CHILD-CAREGIVER OBSERVATION SYSTEM (C-COS) 

IN CHILD CARE CENTERS AT SELECTED MIXED-APPROACH SITES

 24 Months 36 Months 

 Program Control Program Control 

Incidents of Any 

Caregiver Talk 33.8 (12.4) 27.6 (13.2)*** 26.7 (12.2) 28.8 (13.3) 

Range 6 – 59 6 – 59 5 – 60 5 – 59 

N 90 47 93 73 

 

Incidents of Caregiver 

Responding to Child 11.9 (13.0) 6.4 (6.3)*** 8.7 (8.2) 8.4 (7.7) 

Range 0 – 58 0 – 31 0 – 38 0 – 35 

N 90 47 93 73 

 

Incidents of Caregiver 

Initiating Talk with Child 22.8 (11.3) 21.9 (9.4) 19.1 (10.3) 21.4 (11.3) 

Range 0 – 58 5 – 42 0 – 55 0 – 56 

N 90 47 93 73 

 

Incidents of Negative 

Behavior 4.5 (5.8) 3.4 (4.5) 3.0 (4.2) 3.0 (4.4) 

Range 0 – 36 0 – 20 0 – 17 0 – 21 

N 90 47 93 73 

Source: Based on observations of “eligible” care arrangements, defined as care that occurs for 

at least 10 hours per week outside a child’s home, or by a nonrelative in the child’s 

home. Only one arrangement per child was observed. 

Note: Based on observations at four mixed-approach sites at 24 months and five sites at 36 

months. Possible range of number of incidents is 0 to 60 over a 2-hour observation 

period. 

***Program-control difference is statistically significant at the .01 level. 
96 

higher levels of quality center care than control children received. In the four center-based sites, 

average classroom global quality was consistently higher for the centers attended by Early Head 

Start children than for the centers control children attended. Early Head Start children 

experienced better child-adult ratios than their control counterparts, and their caregivers were 

rated more favorably. Early Head Start children in sites with mixed-approach programs also 

benefited from being in the program, but the program-control differences in levels of classroom 

quality were smaller than those in the center-based sites. 

E. RELATIONSHIPS BETWEEN CHILD CARE QUALITY AND INTENSITY AND 

CHILD OUTCOMES AMONG EARLY HEAD START CHILDREN 

We examined whether associations between child care quality and the intensity of child care 

use among Early Head Start children were related to three key child outcomes at 24 and 

36 months of age. These analyses included a different sample than the impact analyses just 

described, as we included available observational data obtained from the settings of all children 

in center care across all types of Early Head Start programs (center-based, home-based, and 

mixed) and included children who had been observed at least once. Child care quality was 

measured by the ITERS or ECERS-R and by child-adult ratio. Intensity was measured by 

average hours in center child care. 

Child outcomes were assessed when children were 24 months old, using the Bayley Scales 

of Infant Development Mental Development Index (BSID-MDI), the MacArthur Communicative 

Development Inventory (CDI) language production scale, and the Child Behavior Checklist 

(CBCL) aggressive behavior scale (see ACYF 2001, Chapter V, for details). At 36 months, 

children were assessed on the BSID-MDI, the Peabody Picture-Vocabulary Test-Third Edition 

(PPVT-III), and the CBCL aggressive behavior scale (see ACF 2002b, Chapter V, for details). 
97 

Using Ordinary Least Squares (OLS) regression analyses, we examined how indices of child 

care quality (ITERS or ECERS-R and child-adult ratio), and intensity of child care (average 

hours in care) were related to child outcomes at 24 and 36 months. Mean quality and intensity 

scores at 14 and 24 months were used to predict 24-month outcomes; mean quality and intensity 

scores at 14, 24, and 36 months were used to predict 36-month outcomes. All regression 

analyses controlled for child gender, child age at time of assessment, maternal race/ethnicity, 

mother’s education and marital status, whether mother was a teenager (under 19 years of age) at 

the time of the child’s birth, and whether the site was urban. Appendix Table A.6 presents 

descriptive statistics for the child outcome measures and child care quality and use measures 

included in these analyses. Results of the regression analyses are shown in Appendix Table A.7. 

Among the Early Head Start children who attended child care centers, those in higherquality center care showed enhanced developmental outcomes. Mean child care quality over 

time predicted higher scores on the 24-month Bayley MDI and 36-month PPVT-III. Mean childadult ratio over time did not significantly predict child outcomes. Mean hours in center care over 

time predicted higher scores on the 24- and 36-month Bayley and the 36-month PPVT-III. 

Neither the quality nor the intensity of child care predicted child aggressive behavior at 24 or 

36 months. 

Three interactions were tested separately for each outcome at each age level: (1) quality by 

hours in care, (2) quality by child-adult ratio, and (3) hours in care by child-adult ratio. Of the 

interactions tested, only one was significant: hours in care by ratio predicted 24-month 

aggressive behavior problems and the 36-month Bayley. For children in centers with higher 

child-adult ratios (that is, with less-favorable ratios), more hours in care was related to more 

behavior problems at 24 months. For children in centers with more-favorable child-adult ratios, 

more hours in care was not significantly related to behavior problems at 24 months. 
98 

Consistent with previous research, these findings demonstrate that among this sample of 

Early Head Start children, the quality of the child care centers they attend was positively 

associated with children’s cognitive and language development. Further, (1) spending more time 

in center-based child care was associated with higher cognitive scores at 24 and 36 months and 

higher language scores at 36 months; and (2) more time in child care was related to increased 

behavior problems only if children were in settings with worse child-adult ratios (and only at 

24 months). 

As with all studies of such relationships, we must interpret the associations with some 

caution, in that selection factors could at least partially account for the relationships between 

quality and child outcomes. In this analysis, however, it is reasonable to expect selection bias to 

be less an issue than in most child care studies. All children in the sample included here were in 

families who applied for, and were enrolled in, Early Head Start programs. A substantial portion 

of their child care settings either were provided by the Early Head Start program or were 

arrangements to which the program referred families. Thus, it is less likely that selection factors 

affected which classrooms children attended.10 Follow-up analyses will consider such issues as 

child care mediating the impact of Early Head Start on child outcomes in the full sample of Early 

Head Start and control-group children, corrections for potential selection factors, and quality of 

child care in home and family-based settings. 

 10In addition, the 24- and 36-month child care quality observations were conducted at 

approximately the same time as the 24- and 36-month child outcomes were assessed, making it 

difficult to draw a casual inference between the quality measures and child outcomes. 
99

IV. SUMMARY AND CONCLUSIONS 

Finding good-quality child care is a challenge all parents face, but is especially difficult for 

low-income families. From its very beginning, the national Early Head Start program has taken 

on the challenge of ensuring that all settings used by Early Head Start families, whether provided 

directly by the program or not, meet the high quality standards embodied in the Head Start 

Program Performance Standards. In carrying out the national Early Head Start Research and 

Evaluation project, we collected extensive data on the child care settings used by Early Head 

Start and control group families for their children. This policy report has described the patterns 

of child care used by Early Head Start families, the levels of quality in the centers and family 

child care homes that Early Head Start families used, and the degree of parents’ satisfaction with 

the care received. It has also described the impacts of Early Head Start on child care use and 

quality, based on analyses that take advantage of the randomized design of the national 

evaluation. 

A high proportion of Early Head Start families placed their children in child care during the 

evaluation period, with higher child care use among those in center-based sites. This was to be 

expected because center-based programs recruited families who were looking for full-time child 

care. Compared with families not using child care, those who did were more likely to be single 

parents, employed, and have more education. How much child care they used (the intensity of 

child care use) increased somewhat as children got older, going from an average of 29 hours a 

week in any child care around the time the Early Head Start children were 14 months old to 

32 hours when they were 36 months. Nearly two-thirds of 3-year-old Early Head Start children 

spent at least 30 hours per week in some kind of child care arrangement. Children’s primary 

child care arrangement was most likely to be a child care center, with 48 percent of children 
100

having a center as their primary arrangement at age 3; 35 percent were in less-formal settings, 

with about one-third of those in nonrelative care, one-third cared for by grandparents, and the 

other third by other relatives.1

Using standard, objective measures of child care process quality, we found that Early Head 

Start children attending classrooms in Early Head Start centers consistently experienced good 

quality care, on average, across the three age points, with only slight variation among centers 

(between average ratings of 5.0 and 5.2 on the ITERS and ECERS-R). The quality of 

community centers Early Head Start children attended was somewhat lower, but improved over 

time, going from a mean of 3.8 on the ITERS at 14 months to 4.9 on the ECERS-R at 36 months. 

Overall, at age 3, Early Head Start children in center child care, whether operated by Early Head 

Start programs or not, experienced good quality, averaging 5.0 on the ECERS-R. Child-adult 

ratios in Early Head Start centers consistently met the stringent requirements of the Head Start 

Program Performance Standards, but increased from ratios of 2.6 children per adult at 14 months 

to 3.0 to 1 at 24 months and 4.5 to 1 at 36 months. Furthermore, child-adult ratios in Early Head 

Start centers were all consistently lower (more favorable) than the ratios children experienced 

when they were in community centers. 

Unfortunately, we cannot characterize the quality of care in informal or family child care as 

reliably as center care—because we were not as successful in gaining access to less-formal 

settings, the sample is smaller and subject to potential bias. Nevertheless, the process quality of 

family child care used by Early Head Start children generally appeared to be lower than the 

quality in centers Early Head Start children used. As with center care quality, quality in family 

 1

We defined “primary” child care arrangement as the one the child was in for the most hours 

per week among arrangements that were at least 10 hours per week and that lasted for 2 weeks or 

more. 
101

child care also improved slightly over time, but it but remained substantially lower than center 

quality in the sample we observed. Average FDCRS ratings increased from 3.4 at 14 months to 

3.9 at age 3, still well below what is typically considered good quality care. Child-adult ratios in 

family child care were good, increased somewhat as children got older (from 3.2 to 1 at 

14 months of age to 4.0 to 1 at age 3), but remained within the range of acceptable quality for 

child-adult ratios. 

A unique feature of the Early Head Start child care data were observations of specific 

interactions of the focus child with his or her caregiver in the child care settings where the global 

quality ratings were conducted at 2 and 3 years of age. In about half the observation periods 

coded using the Child-Caregiver Observation System (C-COS), Early Head Start caregivers were 

observed talking with the focus child, and the frequency of caregiver talk was greater in Early 

Head Start than in community centers when children were 3 years old (but not when they were 

2). Early Head Start caregivers also initiated talk with the child more than caregivers in 

community centers did, but at age 3 only. Incidents of negative child behavior were very low for 

all Early Head Start children, and the incidence was not different in Early Head Start and 

community centers at either age. C-COS data suggested that Early Head Start children in family 

child care experienced somewhat more caregiver talk than children in center care, in contrast to 

the global quality differences between the two modes of care.

Although these observational measures of quality are important, the perceptions of the 

consumers—the Early Head Start parents—are also important. Across all types of providers 

used, of all the Early Head Start parents with children in child care at 28 months after 

enrollment, very high percentages reported being satisfied with their recent primary child care 

arrangement—they liked the arrangement in terms of how much attention the child received, 

how much he or she was learning, its safety features, and how “good” they thought the provider 
102

was with children. Even with high levels of satisfaction, however, 29 percent of parents said 

they would like to change the arrangement, if cost were not a factor (at 28 months after enrolling 

in Early Head Start). This finding applies to parents with children in community centers, as well 

as to those in Early Head Start centers. Over time, the parents across all program approaches 

who were using child care found their child care arrangements more acceptable (at 7 months 

after enrollment, 38 percent had said they wanted to change arrangements). The longer families 

were enrolled in Early Head Start (and the older their children were), the more likely they were 

to be using a child care arrangement they liked. When parents expressed an interest in changing 

arrangements, the overwhelming preference was for center care (80 percent of parents at 

28 months after enrollment), although small percentages of parents did prefer relative care or 

other arrangements. When parents wanted to switch to center care, their main reasons were that 

they wanted their child to learn better and to be with other children. When parents wanted to 

change to relative care, it was mainly to ensure the child’s safety and for convenience. 

In the impact analyses, using all 17 sites in the research sample, we found that at all ages 

Early Head Start programs significantly increased the percentage of families using any child 

care, the percentage using center care, and the average hours per week that children were in care. 

Program participation also led to a smaller percentage of parents with primary care arrangements 

during nonstandard hours—during both evening and weekend hours. Whether this is helpful to 

families depends on their work schedules. Most important, however, Early Head Start programs 

significantly, and dramatically, increased the percentage of children who were in good-quality 

center care at all ages at the four center-based sites and selected mixed-approach sites. Based on 

the analysis of ITERS scores, Early Head Start children were three times more likely to be in 

good-quality center care than were control group children at 14 and 24 months of age (and about 

one and a half times more likely to be in a good-quality centers at 36 months, according to the 
103

ECERS-R scores). These impacts occurred with all our measures of process quality—the global 

measures of quality (ITERS and ECERS-R), child-adult ratios, and the specific child-caregiver 

interaction measures. 

This paper also has provided evidence of the likelihood that participation in the Early Head 

Start program is responsible for the program-control differences in quality that we observed at a 

subset of sites. Children in Early Head Start centers experienced significantly higher quality 

than did control group children in the same sites—on the ITERS at 14 and 24 months of age and 

on the ECERS-R at 36 months, on the Arnett scale at all three ages, and on child-adult ratios at 

all age points. Except for the 36-month age point, where the differences were smaller, though 

still statistically significant, the program-control differences were substantial. For example, at 

14 and 24 months of age, the program group was about one point higher on the ITERS. 

Program-control differences in child-adult ratios were also dramatic: Early Head Start children 

experienced center settings in which there was about one fewer child per adult than the control 

group experienced (for example, 2.8 to 1 versus 3.9 to 1 at 14 months, and 5.6 to 1 versus 6.8 to 

1 at 36 months). 

Program-control differences were not as large on the child-caregiver interaction measures, 

although almost all differences favored Early Head Start centers. The significant differences 

included a higher number of incidents of any caregiver talk in both center-based and mixedapproach sites at 24 months and incidents of caregiver responding in mixed-approach sites when 

children were 24 months old. 

Analyses within the Early Head Start program sample demonstrate that amount and quality 

of center care are associated with positive developmental outcomes for the children, a finding 

that is consistent with an extensive child care research literature. 
104

Taken together, the results reported in this policy paper demonstrate the highly important 

role Early Head Start programs have played in responding to the vision of the Advisory 

Committee on Services for Families with Infants and Toddlers. Early Head Start families were 

not only receiving more child care but substantially more good-quality center child care than 

they would have received without the intervention of the Early Head Start programs. Along 

critical dimensions, the quality of Early Head Start center child care was higher than the quality 

control group children experienced, and evidence suggests that this quality is important for 

enhancing the children’s development. 
105

REFERENCES 

Administration for Children and Families. Child Care and Development Fund (CCDF) Report 

of State Plans FY 2002-2003. Washington, DC: Child Care Bureau, U.S. Department of 

Health and Human Services, December 2002(a). 

Administration for Children and Families. Making a Difference in the Lives of Infants and 

Toddlers and Their Families: The Impacts of Early Head Start. Washington, DC: DHHS, 

June 2002(b). 

Administration for Children and Families. Pathways to Quality and Full Implementation in 

Early Head Start. Washington, DC: DHHS, 2002(c). 

Administration on Children, Youth and Families. Leading the Way: Characteristics and Early 

Experiences of Selected First-Wave Early Head Start Programs. Volume I: Cross-Site 

Perspectives. Washington, DC: DHHS, 1999. 

Administration on Children, Youth and Families. Leading the Way: Characteristics and Early 

Experiences of Selected First-Wave Early Head Start Programs. Volume III: Program 

Implementation. Washington, DC: DHHS, 2000. 

Administration on Children, Youth and Families. Building Their Futures: How Early Head Start 

Programs Are Enhancing the Lives of Infants and Toddlers in Low-Income Families. 

Volumes I-II. Washington, DC: DHHS, 2001. 

Arnett, J. “Caregivers in Day-Care Centers: Does Training Matter?” Journal of Applied 

Developmental Psychology, vol. 10, 1989, pp. 541-552. 

Boller, K., S. Sprachman, and the Early Head Start Research Consortium. “The Child-Caregiver 

Observation System Instructor’s Manual.” Princeton, NJ: Mathematica Policy Research, 

Inc., January 1998. 

Capizzano, Jeffrey, Gina Adams, and Freya Sonenstein. “Child Care Arrangements for Children 

Under Five: Variation Across States.” Assessing the New Federalism, Series B, No. B-12. 

Washington, DC: The Urban Institute, March 2002. 

Capizzano, Jeffrey, and Gina Adams. “The Hours that Children Under Five Spend in Child 

Care: Variation Across States.” Assessing the New Federalism, Series B, No. B-08. 

Washington, DC: The Urban Institute, March 2000. 

Carnegie Corporation of New York. Starting Points: Meeting the Needs of Our Youngest 

Children. New York: Carnegie Corporation of New York, 1994.

Collins, Ann M., Jean I. Layzer, J. Lee Kreader, Alan Werner, and Fred B. Glantz. “National 

Study of Child Care for Low-Income Families: State and Community Substudy Interim 

Report.” Cambridge, MA: Abt Associates, Inc., 2000. 
106

Cost, Quality, and Child Outcomes Study Team. Cost, Quality, and Child Outcomes in Child 

Care Centers; Public Report. Denver: University of Colorado at Denver, January 1995. 

Duncan, Greg, Katherine Magnuson, and Jens Ludwig. “The Endogeneity Problem in 

Developmental Studies.” Research in Human Development, vol. 1, no. 1. (in press).

Ehrle, Jennifer, Gina Adams, and Kathryn Tout. “Who’s Caring for Our Youngest Children? 

Child Care Patterns of Infants and Toddlers.” Assessing the New Federalism, Occasional 

Paper Number 42. Washington, DC: The Urban Institute, 2001. 

Emlen, Arthur C. “From a Parent’s Point of View: Flexibility, Income, and Quality of Child 

Care.” Background Paper for the SEED 2000 meeting, “Child Care in the New Policy 

Context,” NIH Campus, Bethesda, MD, April 30 and May 1, 1998. Portland, OR: Portland 

State University, 1998. 

Emlen, Arthur C., Paul E. Koren, and Kathryn H. Schultze. “From a Parent’s Point of View: 

Measuring the Quality of Child Care.” Final Report to the Child Care Bureau. Portland, 

OR: Portland State University, 1999. 

Harms, Thelma, and Richard Clifford. Family Day Care Rating Scale. New York: Teachers 

College Press, 1989. 

Harms, T., R. Clifford, and D. Cryer. Early Childhood Environment Rating Scale-Revised. New 

York: Teachers College Press, 1998. 

Harms, Thelma, Debra Cryer, and Richard Clifford. Infant/Toddler Environment Rating Scale. 

New York: Teachers College Press, 1990. 

Helburn, S.W. (Ed.). Cost, Quality, and Child Outcomes in Child Care Centers: Technical 

Report. Denver: Department of Economics, Center for Research in Economic and Social 

Policy, University of Colorado, 1995. 

Howes, C., D. Phillips, and M. Whitebook. “Thresholds of Quality: Implications for the Social 

Development of Children in Center-Based Child Care.” Child Development, vol. 63, 1992, 

pp. 449-460. 

Howes, C., and E. Smith. “Relations Among Child Care Quality, Teacher Behavior, Children’s 

Play Activities, and Cognitive Activity in Child Care.” Early Childhood Research Quality 

Quarterly, vol. 10, 1995, pp. 381-404. 

Kisker, Ellen Eliason, Sandra L. Hofferth, Deborah A. Phillips, and Elizabeth Farquhar. “A 

Profile of Child Care Settings: Early Education and Care in 1990.” Washington, DC: U.S. 

Department of Education, 1991. 

Larner, Mary, and Deborah Phillips. “Defining and Valuing Quality as a Parent.” In Valuing 

Quality in Early Childhood Services: New Approaches to Defining Quality, edited by Peter 

Moss and Alan Pence. New York: Teachers College Press, 1994. 
107

Love, John M., Helen Raikes, Diane Paulsell, and Ellen Eliason Kisker. “New Directions for 

Studying Quality in Programs for Infants and Toddlers.” In Infants and Toddlers in Out-ofHome Care, edited by Debby Cryer and Thelma Harms. Baltimore: Paul H. Brookes 

Publishing Co., 2000. 

Love, John M., Linda Harrison, Abraham Sagi-Schwartz, Marinus H. van IJzendoorn, Christine. 

Ross, J.A. Ungerer, Helen Raikes, Christy Brady-Smith, Kimberly Boller, Jeanne BrooksGunn, Jill Constantine, Ellen E. Kisker, Diane Paulsell, and Rachel Chazan-Cohen. “Child 

Care Quality Matters: How Conclusions May Vary with Context.” Child Development, vol. 

74, 2003, pp. 1021-1033. 

Mitchell, Anne, E. Cooperstein, and Mary Larner. Child Care Choices, Consumer Education, 

and Low-Income Families. New York: National Center for Children in Poverty, 1992. 

Mitchell, Anne, Louise Stoney, and Harriet Dichter. Financing Child Care in the United States: 

An Illustrative Catalog of Current Strategies. Kansas City, MO, and Philadelphia, PA: The 

Ewing Marion Kauffman Foundation and The Pew Charitable Trusts, 1997. 

NICHD Early Child Care Research Network. “Early Child Care and Self-Control, Compliance, 

and Problem Behavior at 24 and 36 Months.” Child Development, vol. 69, 1998, pp. 1145-

1170. 

NICHD Early Child Care Research Network. “The Relation of Child Care to Cognitive and 

Language Development.” Child Development, vol. 71, 2000, 960-980. 

Paulsell, Diane, Renee Nogales, and Julie Cohen. Quality Child Care for Infants and Toddlers: 

Case Studies of Three Community Strategies. Washington, DC: Mathematica Policy 

Research, Inc. and ZERO TO THREE, April 2003. 

Phillips, D.A. (Editor). Child Care for Low-Income Families: Summary of Two Workshops. 

Washington, DC: National Academy Press, 1995. 

Porter, Toni. Just Like Any Parent: The Child Care Choices of Welfare Mothers in New Jersey. 

New York: Bank Street College of Education, 1991. 

Raikes, Helen, John Love, Ellen Kisker, Rachel Chazan-Cohen, and Jeanne Brooks-Gunn. 

“What Works: Improving the Odds for Infants and Toddlers in Low-Income Families.” In 

Early Head Start: Beacon of Hope for America’s Youngest Children, edited by J. Lombardi 

and M. Bogel. Washington, DC: ZERO TO THREE, in press. 

Schumacher, Rachel, Mark Greenberg, and Janellen Duffy. “The Impact of TANF Funding on 

State Child Care Subsidy Programs.” Washington, DC: Center for Law and Social Policy, 

September 2001. 

Smith, Kristin. “Who’s Minding the Kids? Child Care Arrangements: Spring 1997.” Current 

Population Reports, P70-86. Washington, DC: U.S. Census Bureau, July 2002. 
108

U.S. Department of Health and Human Services. The Statement of the Advisory Committee on 

Services for Families with Infants and Toddlers. Washington, DC: U.S. Government 

Printing Office, September 1994. 

U.S. Department of Health and Human Services. “Head Start Program: Final rule.” Federal 

Register, vol. 61, no. 215, November 1966, pp. 57186-57227. 

U.S. Department of Health and Human Services. “Head Start Program: Proposed Rule.” 

Federal Register, vol. 65, no. 168, August 29, 2000, pp. 52394-52400. 

Whitebook, Marcy, Carollee Howes, and Deborah Phillips. “Who Cares? Child Care Teachers 

and the Quality of Care in America: Final Report: National Child Care Staffing Study.” 

Berkeley, CA: Child Care Employee Project, 1989. 
APPENDIX A 

SUPPLEMENTARY TABLES

A.3 

TABLE A.1 

RESPONSE RATES FOR OBSERVATIONS OF EARLY HEAD START AND CONTROL GROUP 

AND FAMILY CHILD CARE ARRANGEMENTS AT 14 MONTHS OF AGE 

Number of Center 

Arrangements 

Observed 

Center Response Ratea 

(Percentage) 

Number of Family Child 

Care Arrangements 

Observed 

Site EHS Control EHS Control EHS Control Center-BasedSite #1 44 17 83 74 0 3 Site #2 55 16 92 84 0 4 Site #3 25 6 86 100 1 3 Site #4 44 13 86 76 4 8 Center Total 168 52 87 80 5 18 

Home-Based Site #5 2 1 25 50 7 5 Site #6 1 0 25 0 3 4 Site #7 1 0 13 0 8 6 Site #8 13 4 87 44 5 0 Site #9 5 0 45 0 1 3 Site #10 0 3 0 75 3 7 Site #11 3 2 43 40 3 2 Home Total 25 10 45 30 30 27 Mixed Site #12 13 8 72 62 3 6 Site #13 11 2 73 17 13 9 Site #14 3 0 20 0 0 1 Site #15 31 7 91 54 3 0 Site #16 11 2 79 50 7 8 Site #17 12 11 71 69 6 7 Mixed Total 81 30 72 49 32 31 Sample Total 274 92 76 58 67 76 

aResponse rates indicate the percentage of eligible center or family child care arrangements we were able to locate and obse
A.4 

TABLE A.2 

RESPONSE RATES FOR OBSERVATIONS OF EARLY HEAD START AND CONTROL GROUP CEN

AND FAMILY CHILD CARE ARRANGEMENTS AT 24 MONTHS OF AGE 

Number of Center 

Arrangements Observeda 

Center Response Rateb 

(Percentage) 

Number of Family Child Care 

Arrangements Observeda

Fam

Site EHS Control EHS Control EHS Control Center-BasedSite #1 48 17 94 65 0 1 Site #2 50 11 88 79 0 0 Site #3 19 5 76 83 4 1 Site #4 45 15 96 65 1 11 Center Total 162 48 90 70 5 13 Home-Based Site #5 8 1 50 50 13 7 1Site #6 6 2 55 33 6 9 Site #7 3 1 75 25 10 5 Site #8 13 9 68 60 4 0 Site #9 0 0 0 0 0 1 Site #10 1 7 100 100 7 2 Site #11 4 4 57 100 3 5 Home Total 35 24 49 55 43 29 Mixed Site #12 15 3 71 43 0 2 Site #13 9 8 64 62 15 4 Site #14 10 0 91 0 1 0 Site #15 30 9 86 53 1 4 Site #16 17 7 100 64 10 2 Site #17 12 17 52 74 7 5 Mixed Total 93 44 77 61 34 17 Sample Total 290 116 78 63 82 59 aNumber of observed arrangements were determined by the number of valid ITERS or FDCRS scales we were able to calculate. Samp

developed from the C-COS are slightly larger. 

bResponse rates indicate the percentage of eligible center or family child care arrangements we were able to locate and observe.
A.5 

TABLE A.3 

RESPONSE RATES FOR OBSERVATIONS OF EARLY HEAD START AND CONTROL GROUP CENTE

FAMILY CHILD CARE ARRANGEMENTS AT 36 MONTHS OF AGE 

Number of Center 

Arrangements Observeda 

Center Response Rateb 

(Percentage) 

Number of Family Child Care 

Arrangements Observeda 

Fam

Site EHS Control EHS Control EHS Control Center-BasedSite #1 43 25 91 83 1 3 Site #2 47 14 100 74 0 0 Site #3 17 18 65 90 1 1 Site #4 46 15 102 75 2 4 Center Total 153 72 93 81 4 8 Home-Based Site #5 20 5 63 45 9 6 1Site #6 9 4 100 50 4 9 Site #7 19 15 86 94 5 8 Site #8 12 4 36 22 0 0 Site #9 0 0 0 0 0 0 Site #10 3 3 50 75 3 5 Site #11 6 4 75 80 5 6 Home Total 69 35 55 42 26 34 Mixed Site #12 20 8 80 50 0 0 Site #13 10 7 67 41 11 2 Site #14 10 2 67 17 1 2 Site #15 25 19 78 86 1 1 Site #16 15 8 63 73 6 3 Site #17 14 22 58 76 6 2 Mixed Total 94 66 70 62 25 10 Sample Total 316 173 74 62 55 52 aNumber of observed arrangements were determined by the number of valid ECERS or FDCRS scales we were able to calculate. Samp

developed from the C-COS are slightly larger. 

bResponse rates indicate the percentage of eligible center or family child care arrangements we were able to locate and observe.
A

.6 

TABLE A.4 

BACKGROUND CHARACTERISTICS OF PROGRAM AND CONTROL-GROUP FAMIL

WITH CHILDREN IN CENTER CHILD CARE AT CENTER-BASED SITES 

(Percentages) 

Age of Child 14 Months 24 Months 

Characteristic at Enrollment Program Control Program Control ProgrPregnant 10 12 9 13 8 Child Was 5+ Months Old 61 55 65 52 63 Primary Language Was not 

Englisha 11 12 9 13 7 

Parent Lived with Partner 13 24* 15 31*** 14 Family Income 67% to 99% 

of Poverty Line 21 22 22 33* 22 

Other Race 2 10** 3 4 4 Parent Unemployed 27 14* 24 13 24 Welfare Work Requirementsb 85 88 88 90 89 

Sample Size 165 51 162 48 153 

Source: Sample is based on families who reported being in an eligible care arrangement whom we were able 

ITERS or ECERS-R score Baseline characteristics taken from the HSFIS enrollment data. 

aParent reported English was not primary language spoken, but could speak English well. bFamily lived in a state with TANF work requirement for women with children younger than 12 months. *Difference is statistically significant at the .10 level.  **Difference is statistically significant at the .05 level. ***Difference is statistically significant at the .01 level. 
A.7 

TABLE A.5 

BACKGROUND CHARACTERISTICS OF PROGRAM AND CONTROL-GROUP FAMIL

WITH CHILDREN IN CENTER CHILD CARE AT SELECTED MIXED-APPROACH SIT

(Percentages) 

Age of Child 14-Months 24-Months 

Characteristic at Enrollment Program Control Program Control ProChild Was 5+ Months Old 31 25 27 22 Child had Environmental Risks 52 22** 30 33 Pregnant 30 32 36 39 Teenage Mother 61 36 49 43 Parents had Less than 9 Years of Education 10 0* 9 8 Primary Language Was not Englisha 3 11 3 3 Parent Lived with Partner 10 18 10 22* Adult Male in Household 27 54*** 27 47** 

Family Income 33% to 67% of Poverty Line 33 14* 38 31 Family Income 67% to 99% of Poverty Line 16 36** 14 28* Family Received Welfare 67 42** 64 50 African American 55 36* 49 36 Parent in School or Training 45 18*** 35 20* Parent Was Unemployed 22 36 25 37 Urban = Setting 37 68*** 37 56* Welfare Work Requirementsb 19 29 21 8* 

Source: Sample is based on families who reported being in an eligible care arrangement whom we were able t

ITERS or ECERS-R score. Baseline characteristics taken from the HSFIS enrollment data. 

aParent reported English was not primary language spoken, but could speak English well. bFamily lived in a state with TANF work requirement for women with children younger than 12 months.  *Difference is statistically significant at the .10 level.  **Difference is statistically significant at the .05 level. ***Difference is statistically significant at the .01 level. 
A.8 

TABLE A.6 

 DESCRIPTIVE STATISTICS FOR CHILD CARE AND CHILD OUTCOMES 

FOR EARLY HEAD START CHILDREN IN CENTER CARE 

AT LEAST ONCE FROM 14 TO 36 MONTHS OF AGE 

 Mean SD Minimum Maximum 

Child Care Quality 

Mean ITERS (14 Months) 4.7 1.12 1.50 6.80 

Mean ITERS (24 Months) 5.0 1.08 1.65 6.76 

Mean ECERS (36 Months) 5.0 1.11 1.24 6.82 

Mean ITERS (14 to 24 Months) 4.8 1.10 1.57 6.76 

Mean ITERS/ECERS (14 to 36 Months) 4.9 1.07 1.24 6.79 

 

Child-Adult Ratio (14 Months) 2.9 1.23 0.83 7.70 

Child-Adult Ratio (24 Months) 3.5 1.56 1.00 11.58 

Child-Adult Ratio (36 Months) 5.5 2.64 0.78 14.83 

Child-Adult Mean Ratio (14 to 24 Months) 3.3 1.37 0.93 11.58 

Child-Adult Mean Ratio (14 to 36 Months) 4.2 1.87 0.78 13.10 

 

Child Care Intensity 

Average Weekly Center Hours, 14 Months 22.9 17.67 0.0 75.0 

Average Weekly Center Hours, 24 Months 26.9 17.39 0.0 80.0 

Average Weekly Center Hours, 36 Months 28.3 17.01 0.0 60.0 

Average Weekly Center Hours, 14 to 24 Months 24.7 15.49 5.50 55.0 

Average Weekly Center Hours, 14 to 36 Months 26.1 12.75 1.33 55.0 

 

Child Outcomesa 

24-Month BSID-MDI 90.8 13.01 49.0 118.0 

24-Month CDI:Language 57.1 23.17 3.0 100.0 

24-Month CBCL: Aggressive Behavior 21.2 10.64 0.0 57.0 

36-Month BSID-MDI 91.9 11.83 51.0 121.0 

36-Month PPVT-III 84.5 15.03 40.0 125.0 

36-Month CBCL 18.2 10.64 0.0 62.0 

a

BSID = Bayley Scales of Infant Development Mental Development Index 

CDI = Communicative Development Inventory 

CBCL = Child Behavior Checklist 

PPVT-III = Peabody Picture Vocabulary Test, Third Edition
A.9 

TABLE A.7 

SUMMARY OF OLS REGRESSIONS PREDICTING CHILD OUTCOMES 

AT 24 AND 36 MONTHS OF AGE 

24-Month Outcomes 36-Month O

BSID-MDI CDI Language 

CBCL 

Aggression BSID-MDI PPVT

Mean ITERS/ECERS-R 

1.58** 

(.74) 

.53 

(1.37) 

-.79 (.61) 

.49 

(.64) 

1.34

(.8

Mean Child-Adult Ratio 

.32 

(.64) 

-1.15 (1.12) 

.48 

(.50) 

.40 

(.33) 

.10 

(.4

Mean Hours in Center Care 

.13** 

(.06) 

.06 

(.12) 

-.03 (.05) 

.15*** 

(.05) 

.15

(.0

Adj R2 .13*** .04** -.01 .13*** .17

Sample Size 284 308 306 336 293 Note: Unstandardized beta coefficients (with standard errors) presented. Mean scores from 14 to 24 mon

models predicting 24-month outcomes; mean scores from 14 to 36 months were included in models outcomes. All models control for the following: child gender, child age at time of assessment, m

education and marital status, whether mother was teenage (<19 years) at child’s birth, and whether site w

*p < .10; **p < .05; ***p < .01. 

APPENDIX B 

PROCEDURES FOR TRAINING AND ESTABLISHING RELIABILITY ON THE 

CLASSROOM OBSERVATION QUALITY MEASURES 

B.3

Mathematica Policy Research (MPR) trained more than 80 observers to collect child care 

quality data in preparation for the first set of observations (conducted when the children were 

14 months old). Prior to attending centralized training sessions, observers reviewed detailed 

training manuals that described the instruments and study procedures. The first day of training 

included a combination of lecture, interactive discussion, and viewing and discussion of the 

Infant-Toddler Environment Rating Scale (ITERS) or Family Day Care Rating Scale (FDCRS) 

videotaped training materials. On the following two days of training, MPR group leaders (who 

had established inter-rater reliability with two of the instruments’ developers, Thelma Harms and 

Debby Cryer, prior to the training session) accompanied small groups of observers into the local 

community to conduct one center and one family child care observation. After the observation, 

the group leader answered questions about any information needed to score items that could not 

be observed. All observers independently scored each item. The group leader then facilitated a 

discussion of each item, spending time discussing items on which there was disagreement about 

the score. The group came to a consensus score for each item and the group leader computed the 

percent agreement for each observer against the consensus score. To be certified to collect Early 

Head Start child care observation data, observers had to have rated items within one scale point 

of the consensus score on 80 percent of the ITERS, FDCRS, and Arnett Caregiver Interaction 

Scale (CIS) items. After returning to their sites, observers were also required to conduct one 

center and one family child care within-site reliability practice visit with another observer from 

their site and again meet the certification requirements. MPR reviewed the reliability data from 

those visits. Almost all observers met the certification criteria in their first attempt. We worked 

with those who did not to further explain items and indicators and asked the observers to conduct 

additional practice visits until they met the certification requirements of establishing reliability 

on two post-training observations. 
B.4

Given that the main child care observation measures did not change from 14 to 24 months, 

we focused the 24-month child care data collection training on preparing observers to conduct 

the Child-Caregiver Observation System (C-COS). Following one day of classroom instruction 

on the C-COS, five MPR group leaders led groups of head trainers/lead observers from each site 

in conducting visits to community child care settings to establish reliability on the ITERS, 

FDCRS, and Arnett CIS and to practice the C-COS in the context of a full child care quality 

observation. After training and any local training of additional observers, we also asked them to 

conduct two within-site reliability visits. Again, very few observers did not meet the reliability 

criteria. For the C-COS, we developed test videotapes and compared observers’ codes with the 

codes developed by a team of gold standard coders to establish reliability. For the 36-month 

observations, we adopted a site-based training model and distributed detailed training manuals 

and videotapes to the sites, where experienced local site coordinators conducted the training. 

Training in conducting the Early Childhood Environment Rating Scale-Revised (ECERS-R) 

followed the same pattern described for the ITERS and FDCRS. The criteria for certification 

were the same as described above and almost all observers met them on the first attempt. As 

before, if an observer did not meet the criteria, we worked with him or her to answer any 

questions and required that he or she conduct additional practice reliability visits until they met 

the criteria.