Child Care and Early Childhood Education: More Information Sharing and Program Review by HHS Could Enhance Access for Families with Limited English Proficiency
Published: 2006-08-17T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Questions have been raised about whether parents with limited English proficiency are having difficulty accessing child care and early education programs for their children. Research suggests that quality early care experiences can greatly improve the school readiness of young children. GAO was asked to provide information on (1) the participation of these children in programs funded through the Child Care and Development Fund (CCDF) and Head Start, (2) the challenges these families face in accessing programs, (3) assistance that selected state and local entities provide to them, and (4) actions taken by the Department of Health and Human Services (HHS) to ensure program access. To obtain this information, GAO analyzed program and national survey data, interviewed officials in 5 states and 11 counties, held 12 focus groups with mothers with limited English proficiency, and interviewed experts and HHS officials.
section_title: What GAO Found
paragraphs: HHS's Child Care Bureau (CCB) did not have information on the total enrollment in CCDF programs of children whose parents had limited English proficiency, but data collected by its Office of Head Start in 2003 showed that about 13 percent of parents whose children were in Head Start reported having limited English proficiency. The most recent (1998) national survey data showed that children of parents with limited English proficiency were less likely than other children to receive financial assistance for child care from a social service or welfare agency or to be in Head Start, after controlling for selected characteristics. Eighty-eight percent of these children were Hispanic, and their results differed from Asian children. Analysis of data from focus groups and site visit interviews held by GAO revealed that mothers with limited English proficiency faced multiple challenges, including lack of awareness of available assistance, language barriers during the application process, and difficulty communicating with English-speaking providers. Some of the challenges that low-income parents with limited English proficiency experienced, such as lack of transportation and shortage of subsidized child care slots, were common to other low-income families. The majority of state and local agencies that we visited offered some oral and written language assistance, such as bilingual staff or translated applications. Agencies in the majority of locations visited also made efforts to increase the supply of providers who could communicate with parents. Officials reported challenges in serving parents with limited English proficiency, such as difficulty hiring qualified bilingual staff. Some officials indicated that additional information on cost-effective strategies to serve this population would facilitate their efforts. HHS issued guidance, translated materials, and provided technical assistance to grantees to help them serve children of parents with limited English proficiency. The Office of Head Start reviewed programs' assessments of their communities' needs and conducted formal monitoring reviews, but could not ensure that review teams consistently assessed grantees' performance on the standards related to language access. CCB reviewed states' plans on the use of CCDF funds generally and investigated specific complaints, but had no mechanism for reviewing how and whether states provide access to CCDF subsidies for eligible children of parents with limited English proficiency.

section_title: Letter
paragraphs: Children whose parents have limited English proficiency are at greater  risk of experiencing difficulties in school than children from English- speaking households. Research suggests that quality early care  experiences can greatly improve the school readiness and future school  success of young children, particularly children at greatest risk of failure.  U.S. Census Bureau data from 2000 indicate that more than 1.6 million  children age 5 and younger lived in households where no one aged 14 or  over reported English proficiency. Census data also show that these  children were more likely than other children to be from low-income  families. There is interest in how this population is faring in accessing  child care and early education programs that can ease children’s transition  to school.
The U.S. Department of Health and Human Services (HHS) administers the  two largest federally funded programs that support early childhood  activities. HHS’s Child Care Bureau (CCB) provides block grants to states  through the Child Care and Development Block Grant, commonly referred  to as the Child Care and Development Fund (CCDF), to subsidize child  care for low-income children while their parents work or participate in  education or training activities. HHS’s Office of Head Start funds local  grantees through its Head Start program, a comprehensive program  designed to foster healthy child and family development and to help low- income children achieve school readiness. States receiving CCDF block  grants and Head Start grantees have limited funds for these programs and  employ priorities and waiting lists to ration services. In fiscal year 2006,  CCDF provided approximately $4.9 billion in federal funds to states and  territories. In fiscal year 2004 (the latest year for which service delivery  data were available), states and territories received about $4.7 billion in  federal funds and served approximately 1.74 million children in their  CCDF programs. In fiscal year 2005, Head Start grantees received about  $6.8 billion in federal funding and served approximately 900,000 children.  The majority of individuals with limited English proficiency are  immigrants—individuals not born in the United States—although most  children of immigrants were born in the United States. Children must be  U.S. citizens or legal residents to receive CCDF subsidies, while a child’s  immigration status is not a factor in determining eligibility for Head Start.  The parent’s immigration status is not relevant for determining eligibility  for either program.
Organizations working on issues affecting children and parents with  limited English proficiency have raised concerns that these families may  have difficulties accessing federally funded child care and early education  programs. In this context, you asked us to answer the following questions:  (1) What is known about the participation of children whose parents have  limited English proficiency in child care and early education programs  funded through CCDF and Head Start? (2) What challenges do these  families face in accessing these programs? (3) What assistance is provided  by selected state and local entities to facilitate access for these families?  (4) What actions has HHS taken to ensure that these families can access  CCDF child care subsidies and Head Start?
To address these issues, we used multiple data collection methodologies.  To determine the participation in federally funded child care and early  education programs by children of parents with limited English  proficiency, we reviewed HHS data from a survey of Head Start  participants and from a reporting system used by Head Start grantees. To  assess the reliability of these data, we interviewed relevant HHS officials  and contractors and reviewed documentation related to the procedures for  collecting and analyzing these data. We found the Head Start survey data  to be sufficiently reliable for the purposes of this report, and while we did  not independently verify the data available through the reporting system,  we found no evidence to suggest that they were unreliable. We also  requested information from all 50 states and the District of Columbia on  their collection of language data for CCDF subsidy recipients. To obtain  information on the child care and early education patterns of these  children that could not be obtained from HHS data, we analyzed national  survey data collected in 1998 as part of the Early Childhood Longitudinal  Study, Kindergarten Class of 1998-99 (ECLS-K), from parents of  kindergarten children about their children’s experiences the year before.  Specifically, we used a logistic regression model to estimate the effect of  parents’ English proficiency on children’s child care and early education  patterns, while controlling for selected individual and family  characteristics such as race and parental education. ECLS-K, conducted by  the National Center for Education Statistics (NCES), was the most recent  national dataset that allowed us to examine child care and early education  experiences of children while considering the English proficiency of their  parents. We assessed the reliability of NCES data and found these data to  be sufficiently reliable for the purposes of this report. To understand the  challenges that parents with limited English proficiency face and what  state and local entities are doing to assist them, we visited five states  (Arkansas, California, Illinois, North Carolina, and Washington) and  contacted 11 counties across these states. We interviewed state and local  officials administering CCDF and Head Start as well as local child care and  early education providers. We selected our site visit locations on the basis  of the size and growth of their population with limited English proficiency,  the presence of any initiatives focused on individuals with limited English  proficiency, and their geographic location. We also conducted 12 focus  groups in California, North Carolina, and Washington with mothers who  spoke Spanish and Vietnamese, reported limited English proficiency, and  had children aged 5 or younger enrolled in child care who likely qualified  for CCDF subsidies based on their family’s income and parental work and  education activities. Six focus groups were conducted with mothers  whose children received a government child care subsidy, and six focus  groups were conducted with mothers whose children were eligible for but  did not receive the subsidy. To determine what HHS is doing to ensure  access to its programs, we interviewed HHS officials from the Office for  Civil Rights (OCR), the Office of Head Start, and CCB, and reviewed  relevant documents, legislation, guidance, and other federal resources  related to language access. Appendix I contains more information about  our scope and methodology. Appendix II contains information on the  regression analysis of ECLS-K data that we conducted. We conducted our  work between July 2005 and June 2006 in accordance with generally  accepted government auditing standards.
subsections: section_title: Background
subsections: section_title: Population Changes
paragraphs: The population of individuals with limited English proficiency in the  United States has grown dramatically in recent years. The 2000 Census  shows that the number of people reporting that they do not speak English  well or very well grew by 65 percent, from 6.7 million in 1990 to almost   11 million in 2000. The data also show that while growth in the population  of individuals with limited English proficiency continues in states along  the border, such as California and Texas, it is most rapid in other states.  (See fig. 1.)
As figure 1 shows, for example, the number of individuals who did not  speak English well or very well increased by more than 300 percent  between 1990 and 2000 in North Carolina and Georgia, and by more than  200 percent in states such as Nebraska, Arkansas, and South Carolina. In  2000, 14 percent of children age 5 and younger in households below the  federal poverty level lived in linguistically isolated households.
section_title: HHS Child Care and Early Education Programs
paragraphs: The two largest sources of federal support for child care and early  education are CCDF and Head Start. CCB administers CCDF and the  Office of Head Start administers Head Start. Both entities are housed  within ACF. CCB provides block grants to states through CCDF to  subsidize child care expenses of eligible families. In contrast, the Office of  Head Start awards grants for the operation of Head Start programs directly  to local public or private organizations, school systems, or Indian tribes.  The flow of funds under CCDF and Head Start is shown in figure 2.
CCDF is used to subsidize the child care expenses of low-income families  with children under age 13 and to improve the overall quality and supply of  child care. The goals of the program are to (1) allow each state maximum  flexibility in developing child care programs and policies; (2) promote  parental choice to empower working parents to make their own decisions  on the child care that best suits their family’s needs; (3) encourage states  to provide consumer education information to help parents make  informed choices about child care; (4) assist states to provide child care to  parents trying to achieve independence from public assistance; and   (5) assist states in implementing the health, safety, licensing, and  registration standards established in state regulations. The parent whose  child receives child care assistance may either enroll the child directly  with a provider who has a grant or contract from the state for the  provision of child care services or receive a certificate to enroll the child  with a provider of the parent’s choosing. Parents may choose from any  child care legally offered in the state, which could include care provided in  child care centers, family child care homes, or by relatives or nonrelatives  in the child or provider’s home. CCDF is a combination of discretionary  and mandatory funds. In federal fiscal year 2006, CCDF provided about  $4.9 billion in federal funds to states and territories. In fiscal year 2004 (the  latest year for which data were available), the program served  approximately 1.74 million children with federal funding of about   $4.7 billion. In addition, federal CCDF funds are supplemented with state  contributions, and HHS officials reported that total federal and state  expenditures for CCDF amounted to almost $9.4 billion in fiscal year 2004.
Congress gave states considerable flexibility in administering and  implementing their CCDF programs. States are required to submit biennial  plans to CCB describing their CCDF activities. States determine income  eligibility thresholds up to a federal maximum of 85 percent of the state  median income. In their CCDF plans for federal fiscal years 2004 and 2005,  almost all states reported setting lower income eligibility limits, with only  5 states at the federal maximum of 85 percent.
Because CCDF is a nonentitlement program—one with limited funding  and not necessarily intended to cover all eligible persons—states are not  required to provide child care subsidies to all families whose incomes fall  below the state-determined eligibility threshold, and states may establish  priorities for serving eligible families, such as prioritizing families  receiving Temporary Assistance for Needy Families (TANF), in order to  support their work efforts. States can augment their CCDF funds with  other funding sources, such as TANF, to increase funding available for  subsidies. States spent $1.4 billion in federal TANF funds directly on child  care in fiscal year 2004. States may also transfer up to 30 percent of their  TANF block grants into their CCDF programs. In fiscal year 2004, the  latest year for which data were available, $1.9 billion in TANF funds was  transferred to CCDF. Funds transferred from TANF to CCDF must be  spent in accordance with CCDF rules. This is significant partly because the  effect of the child’s or the parent’s citizenship or immigration status on the  child’s eligibility differs depending on the program. For example, parents’  immigration status may affect their eligibility for child care assistance  under TANF, whereas only the immigration status of the child matters for  determination of eligibility for subsidies from CCDF. Although legislation  authorizing CCDF did not specify the effect of citizenship or immigration  status on program eligibility, HHS’s guidance to state agencies indicated  that states should consider only the citizenship and immigration status of  the child when determining the child’s eligibility for federal child care  assistance. Therefore, children who are citizens or legal residents are  eligible for CCDF subsidies regardless of their parents’ citizenship or  immigration status.
States are also required to dedicate at least 4 percent of their CCDF  allotments to activities to provide comprehensive consumer education to  parents and to improve the quality and availability of child care. States  may use some of this quality set-aside to fund child care resource and  referral services that are available in every state and most communities in  the United States. These agencies provide information to parents on  finding and paying for quality child care, offer training to child care  providers, and frequently engage in efforts to analyze and report on child  care supply and demand in their communities. Often, resource and referral  agencies also manage the CCDF subsidy program or are part of local  organizations that administer the subsidy in the community.
Head Start offers child development programs to low-income children  through age 5 and their families. The overall goal of Head Start is to  promote the school readiness and healthy development of young children  in low-income families. In addition to providing classroom programs for  the children, Head Start grantees provide or arrange for a variety of  services, including medical, dental, mental health, nutritional, and social  services. Children in families with incomes below the federal poverty level  ($20,000 for a family of four in 2006) are eligible for available Head Start  programs regardless of their or their parents’ immigration status. Head  Start grantees must adhere to certain performance standards, including  standards related to providing language access in Head Start programs.  The Office of Head Start reviews the performance of Head Start grantees  on these standards using a structured guide known as the Program Review  Instrument for Systems Monitoring (PRISM). In fiscal year 2005, Head  Start was funded at $6.8 billion and served 906,993 children.
section_title: Ensuring Meaningful Program Access for Persons with Limited English Proficiency
paragraphs: HHS has responsibility for monitoring grantees’ compliance with program  requirements. Through its Office for Civil Rights (OCR), HHS also oversees  compliance with Title VI of the Civil Rights Act of 1964, which states that  no person shall “on the ground of race, color, or national origin, be  excluded from participation in, be denied the benefits of, or be subjected  to discrimination under any program or activity receiving federal financial  assistance.” HHS has issued regulations to recipients of HHS funds on  implementing the provisions of Title VI, including requiring an assurance  in every application for federal financial assistance that the program will  be operated in compliance with all requirements imposed under HHS’s  Title VI regulations.
Moreover, Executive Order 13166, issued in 2000, required federal  agencies to prepare a plan and issue guidance to their funding recipients  on providing meaningful access to individuals who, as a result of national  origin, are limited in their English proficiency. In August 2003, HHS  published revised guidance pursuant to Executive Order 13166. The  guidance states that Title VI and its implementing regulations require that  grantees take reasonable steps to ensure meaningful access for individuals  with limited English proficiency, and the guidance is intended to assist  grantees in fulfilling their responsibilities to ensure meaningful access to  HHS programs and activities by these individuals. Under the guidance,  grant recipients are to determine the extent of their obligation to provide  language assistance services by considering four factors: (1) the number  or proportion of individuals with limited English proficiency eligible to be  served or likely to be encountered by the program or grantee; (2) the  frequency with which these individuals come in contact with the program;  (3) the nature and importance of the program, activity, or service provided  by the program to people’s lives; and (4) the resources available to  recipients of federal funds and costs of language assistance. The guidance  states that grantees have two main ways to provide language assistance  services: oral interpretation, either in person or via telephone, and written  translation. Finally, the guidance lays out elements of an effective plan of  language assistance for persons with limited English proficiency.
Monitoring compliance with Title VI and providing technical assistance are  functions of HHS’s OCR. OCR enforces Title VI as it applies to agencies’  responsibilities to ensure access for individuals with limited English  proficiency. The mechanisms available to OCR for ensuring that agencies  comply with their obligations to provide access include complaint  investigations, compliance reviews, efforts to secure voluntary  compliance, and technical assistance.
section_title: Children of Parents with Limited English Proficiency Were Less Likely than Other Children to Participate in Subsidized Programs
paragraphs: The most recent national survey data showed that in 1998 children of  parents with limited English proficiency, 88 percent of whom were  Hispanic, were less likely than other children to receive financial  assistance from a social service or welfare agency for child care or to  participate in Head Start in the year before kindergarten, after controlling  for selected individual and family characteristics. However, these data  could not be used to assess their likelihood of enrollment in CCDF  programs because the survey questions did not ask for the specific agency  providing financial assistance. Further, CCB did not have information on  the total enrollment in CCDF programs of children of parents with limited  English proficiency because it did not require states to collect and report  any language data from parents of children receiving federal subsidies,  such as their primary language or English proficiency. The Office of Head  Start collected some data on the language spoken by Head Start  participants, which showed that about 13 percent of parents of the  approximately 900,000 children enrolled in Head Start in 2003 reported  speaking English “not well” or “not at all.”
subsections: section_title: Children of Parents with Limited English Proficiency Were Less Likely to Receive Financial Assistance for Child Care or to Participate in Head Start
paragraphs: National survey data from ECLS-K showed that in 1998, kindergarten  children of parents with limited English proficiency who were in  nonparental child care in the previous year were less likely than other  children in child care to receive financial assistance from a social service  or welfare agency for that care, after controlling for selected individual  and family characteristics. However, parents’ limited English proficiency  had a different effect for Hispanics than for Asians in the dataset.  Specifically, as shown in figure 3, Hispanic children of parents with limited  English proficiency (who represented 88 percent of all children in the  dataset whose parents had limited English proficiency) were less likely  than children of Hispanic parents proficient in English to receive financial  assistance for their care. Among Asians, who constituted about 8 percent  of all children of parents with limited English proficiency, we did not find  a statistically significant difference in the receipt of financial assistance for  child care between children of parents with limited English proficiency  and other children. These results, however, cannot be used to draw  conclusions about enrollment in CCDF programs by children of parents  with limited English proficiency because the survey questions referred to  assistance from a social service or welfare agency generally and did not  ask specifically whether assistance came from CCDF. Also, while ECLS-K  data are representative of the experiences of children in the year prior to  entering kindergarten, they cannot be extrapolated to children of all ages.  (See app. II for discussion of the methodology we used to analyze ECLS-K  data and the results of our analyses.)
Our analysis of ECLS-K data also indicated that after controlling for  selected individual and family characteristics, children of parents with  limited English proficiency were less likely to participate in Head Start in  the year before kindergarten. Again, this result did not hold consistently  across racial and ethnic groups. Specifically, as shown in figure 3, children  of Hispanic parents with limited English proficiency were less likely than  children of Hispanic parents proficient in English to participate in Head  Start in the year before kindergarten. In contrast, children of Asian parents  with limited English proficiency were more likely than children of Asian  parents proficient in English to participate in Head Start.
While 1998 ECLS-K data showed that children of parents with limited  English proficiency were less likely than other children to receive financial  assistance for child care and to participate in Head Start in the year before  kindergarten, it cannot be concluded from these data alone that the  differences are due to language barriers in access to programs. Other  factors, such as the availability of child care and early education programs  in the areas in which members of different language groups reside or  access to support networks that provide information about available  programs may also explain this result. In addition, since the time of the  survey, HHS has taken steps to increase the participation of minorities and  children of parents of parents with limited English proficiency, such as  translating CCDF program brochures and undertaking initiatives to raise  awareness of the Head Start program in the Spanish-speaking community.  Furthermore, HHS officials reported substantial increases in federal and  state child care funding since ECLS-K data had been collected, suggesting  that these increases may have increased program access for parents of  children with limited English proficiency. However, neither CCB nor the  Office of Head Start has more recent information on whether children  whose parents had limited English proficiency are more likely to access  financial assistance for child care and Head Start relative to children  whose parents are proficient in English. ECLS-K was the most recent  national dataset that allowed us to examine the receipt of financial  assistance for child care and the participation in Head Start by children of  parents with limited English proficiency in relation to the participation of  similar children whose parents are proficient in English.
section_title: CCB Does Not Collect Language Data on Children Receiving CCDF Subsidies, and the Data in the 13 States that Collect Them Have Limitations
paragraphs: While CCB requires that states submit a variety of demographic  information in monthly or quarterly reports, such as information on the  race and ethnicity of CCDF subsidy recipients, it collects no information  on the language spoken by or the English proficiency of parents whose  children receive CCDF subsidies. CCB officials told us that they had no  plans to collect language data for those receiving CCDF subsidies because  they generally collect only information specifically listed in the legislation  authorizing CCDF. A CCB official with responsibility for the demographic  data collected from states and officials from 1 state we visited told us that  requiring states to provide language data would create difficulties for  states, such as developing ways to identify individuals with limited English  proficiency. Despite the potential difficulties, various state and local  officials in states that do not collect this information, including the official  who cited potential difficulties collecting the data, told us that having such  data would help them evaluate program performance.
While data on the receipt of CCDF subsidies were not available nationally,  13 states collected some language data from parents whose children  receive CCDF subsidies. The specific type of data collected and the  manner in which these data were collected varied among these 13 states,  preventing comparisons among them on the extent to which state CCDF  programs were serving children of parents with limited English  proficiency. Officials in 10 of the 13 states that collected language data  told us that their states used the data either to provide translated forms or  interpreters to clients during the application process or for planning or  program evaluation purposes, such as identifying areas with significant  increases in the number of individuals with limited English proficiency  and to determine the need for bilingual staff. State data, however, had  limitations that decreased their usefulness in assessing participation in  CCDF programs by children of parents with limited English proficiency.  For example, 5 states made the collection of language data by caseworkers  optional, and officials in another 5 states told us that despite requiring  caseworkers to collect the language data, compliance with the data  requirements could not always be guaranteed. Officials in 8 of the 13 states  that collected language data told us that they could benefit from having  more information on the collection or use of language data or from  learning how other states collect or use them.
section_title: Head Start Data Indicate That about One-Eighth of Participating Children Have Parents with Limited English Proficiency
paragraphs: The Office of Head Start collected some language data from the  approximately 900,000 children enrolled in Head Start and their parents  from two sources. First, the Office of Head Start interviewed parents  through its Family and Child Experiences Survey (FACES), a series of  longitudinal surveys of nationally representative samples of children in  Head Start. Based on the 2003 parent interviews administered, FACES data  showed that about 20 percent of parents of 3- and 4-year-old children in  Head Start reported that a language other than English was most  frequently spoken at home, and about 13 percent of parents reported that  they spoke English “not well” or “not at all.” Second, the Office of Head  Start collected demographic information on all 4- and 5-year-old children  in Head Start through its National Reporting System (HSNRS), including  information on the child’s primary language. These data showed that about  one-quarter of children enrolled in Head Start in Spring 2005 had a primary  language other than English.
section_title: Parents with Limited English Proficiency Faced Multiple Challenges That May Have Limited Their Children’s Participation in Federally Funded Child Care and Early Education Programs
paragraphs: Results from our focus groups, which were composed of mothers with  limited English proficiency whose children were eligible for federal child  care subsidies, revealed that some participants were unaware of the  various federal child care and early education programs that may be  available to them. Parents with limited English proficiency also faced  challenges in the process of applying for programs and financial  assistance, such as lack of interpreters and translated materials. They also  encountered difficulties communicating with English-speaking child care  providers. Some of the challenges to program access that these parents  faced were the same challenges that many low-income families face,  including difficulty finding care at nontraditional hours, lack of  transportation, and the limited availability of subsidized child care slots.
subsections: section_title: Lack of Program Awareness and Challenges during the Application Process May Have Limited Program Participation
paragraphs: Many parents with limited English proficiency were unaware of child care  assistance available to them. All six of the focus groups with Spanish- speaking and Vietnamese-speaking mothers who were eligible but not  receiving subsidies revealed that the majority were unaware of the  assistance available. In addition, the mothers that we interviewed in  Arkansas and focus group participants in North Carolina also told of  misunderstandings and myths that some parents had regarding the  consequences of participating in government-funded programs. For  example, they had heard rumors that if they applied for child care  assistance, their child might one day be drafted into the armed forces to  repay the assistance they received.
Shortages of bilingual staff also presented challenges to parents with  limited English proficiency applying for subsidies for their children. State  and local officials and providers that we interviewed identified the  availability of bilingual staff as a factor that played a role in the ability of  parents with limited English proficiency to apply for the subsidies. For  example, subsidy administration officials in one rural county told us that  they sometimes had to ask clients to come back because no staff were  available to assist them in their language. In three of the four focus groups  with Spanish-speaking mothers with subsidies, those who generally found  the subsidy application process to be easy cited the availability of bilingual  case workers as a factor in allowing them to apply for assistance  successfully.
In addition to shortages of bilingual staff, the lack of available translated  materials also presented challenges to parents with limited English  proficiency. Some programs did not have application forms translated into  other languages, and local officials and parents expressed concerns about  the quality of existing translated materials, saying that they were often  translated by volunteers and that no quality checks were done. For  example, one community group representative told us that volunteers had  translated the Spanish forms that the local subsidy administration office  used and that no quality controls had been applied, resulting in materials  of such poor quality that she advised parents not to request the Spanish  version of the application.
These challenges may be more acute for individuals with limited English  proficiency who speak languages other than Spanish. Local officials in  three states reported that there were limited services available in  languages other than Spanish. For example, local officials in Washington  said that services to smaller, more diverse populations, such as African,  Asian, and East Indian language speakers, were more limited. In North  Carolina and California, local officials also reported that services for  populations such as the Hmong were more limited than for English or  Spanish speakers.
Finally, although immigration status has no impact on Head Start eligibility  and only the immigration status of the child is relevant to the  determination of eligibility for CCDF subsidies, it nonetheless created  indirect challenges for some children of parents with limited English  proficiency. Local officials and community advocates told us that citizen  children of parents with limited English proficiency might not participate  in federal child care and early education programs because of fear within  the family of exposing undocumented immigrant members in the  household. Several officials told us that some of these families were  reluctant to provide personal information and were inhibited from  applying because of fear about how their personal information might be  used. In one case, we discovered a state that improperly required a  declaration of satisfactory immigration status for every member of the  household in order to apply for federally funded child care subsidies,  thereby potentially excluding some children who are U.S. citizens and  otherwise eligible for subsidies. Officials in two states also told us that  many parents with limited English proficiency were paid in cash, making it  difficult to verify their income for eligibility purposes.
section_title: Parents with Limited English Proficiency Had Difficulties Communicating with Providers
paragraphs: Parents reported difficulties communicating with their children’s  providers, and officials reported shortages of providers with the language  ability to serve families with limited English proficiency. For example,  officials at one local resource and referral agency that we visited in the  county with the most Spanish speakers in the state told us that providers  in the county did not have the capacity to meet the needs of families with  limited English proficiency. Spanish-speaking mothers that we interviewed  during a site visit to another state complained that some programs  advertise themselves as bilingual when in reality they are not. Parents in  focus groups also expressed concern about their ability to communicate  with their child care providers. Local officials in one urban area that we  visited said that among the primary challenges faced by families with  limited English proficiency was the effect of the language barrier on the  parents’ ability to communicate with their child care providers.  They  stated this also made it difficult to ensure the same level of parent- provider interaction for families with limited English proficiency as for  other families. For example, one provider with no bilingual staff said that  she had a child with a disability in her center whose parents were limited  in their English proficiency, making it difficult for staff to communicate  with the parents about the child’s needs. These communication difficulties  had consequences in the classroom as well. For example, one Head Start  provider reported instances of therapists and educators who were not  trained to work with Hispanic families inaccurately assessing the needs of  children with language or cultural differences.
section_title: Low-Income Parents with Limited English Proficiency Faced Some of the Same Challenges to Program Access as Other Low-Income Families
paragraphs: Low-income parents with limited English proficiency faced some of the  same challenges when attempting to access child care and early childhood  education programs as other low-income families. Across all states visited,  state and local officials as well as providers said that many low-income  families, especially families with limited English proficiency, work  nontraditional hours and have difficulty finding care that meets their  needs. For example, a resource and referral agency official in one rural  community said that the first shift at a local employer begins at 5:30 a.m.,  while most providers do not offer care before 6:00 a.m., and employees  working second and third shifts face even more difficulty finding child  care. Lack of transportation, especially in rural communities, also restricts  the child care options available to low-income families. Officials said that  it can be especially difficult for families with limited English proficiency to  navigate public transportation or call transit agencies for assistance. In a  previous report, we found that lack of English skills reduced individuals’  ability to access public transportation systems.
Parents in some communities also faced shortages of child care and child  care subsidies, especially for infants and toddlers. Officials with resource  and referral agencies and local subsidy administration offices in 6 of the   11 counties that we contacted said that there were shortages of infant care  in their communities. In addition, because funding for CCDF subsidies was  limited, not all states provided subsidies to all families who applied and  met eligibility criteria. Our prior work showed that 20 states did not serve  all families who met state-determined eligibility criteria, and three of the  five states that we visited (Arkansas, California, and North Carolina) had  waiting lists for CCDF subsidies. In five of the eight focus groups with  Spanish-speaking mothers (including both those receiving and not  receiving subsidies), participants identified waiting lists as one of the  difficulties they faced when seeking assistance for child care. In the two  other states that we visited (Illinois and Washington), state officials said  that although they did not maintain waiting lists, they spent all of the funds  available to them for CCDF subsidies. To manage demand for the limited  financial assistance available for child care, states took steps such as  giving priority to certain groups. For example, in the three states we  visited that maintained waiting lists, two (Arkansas and North Carolina)  set priorities for eligible families, such as preferences for families on or  coming off of TANF. In the third, California, families on or transitioning off  of TANF were provided child care assistance through a guaranteed  funding stream, while funding for other low-income families was capped.  Officials in California told us that this system made it extremely difficult  for low-income families that were not in the TANF system to receive  subsidized child care. While prioritization of TANF families would affect  all low-income families, it may have additional implications for some  children of parents with limited English proficiency. Census 2000 data  show that 82 percent of individuals with limited English proficiency are  foreign-born, and since immigration status is a factor in TANF eligibility,  children of immigrants who do not qualify for TANF would be less likely to  receive CCDF subsidies in those states that give priority to TANF families.  In 2005, we found that 17 of 20 states not covering all applicants who  otherwise met the eligibility criteria gave TANF families priority for CCDF  funds, consistent with CCDF’s goal of providing child care to parents  trying to become independent of public assistance.
section_title: Selected Agencies Took Some Steps to Assist Parents with Limited English Proficiency but Reported Challenges in Serving Them
paragraphs: The majority of state and local agencies and providers that we visited took  some steps to assist parents with limited English proficiency in accessing  child care and early education programs for their children. Most agencies  provided some oral and written language assistance, although the scope of  the assistance varied. Most agencies also implemented initiatives to  increase the supply of providers able to communicate effectively with  parents. Officials told us that they faced several challenges in providing  services to parents with limited English proficiency. Some state and local  officials indicated that additional information on cost-effective strategies  used by others to serve this population would facilitate their efforts to  provide access.
subsections: section_title: Selected State and Local Agencies Offered Language Assistance
paragraphs: The majority of the agencies that we visited had taken some steps to  provide oral and written language assistance, such as interpreters and  translated materials, to parents with limited English proficiency. In all   11 counties that we contacted, the local offices administering CCDF  subsidies and providing resource and referral services offered some oral  language assistance to clients with limited English proficiency although  the scope of the assistance varied. In 5 of these counties, agencies had  staff that could speak several languages, a fact that officials said reflected  the community they served. In the other 6 counties, agency staff had  bilingual capacity for Spanish only, but officials said the vast majority of  the individuals with limited English proficiency they served were Spanish- speaking. Although the subsidy administration office in one of these   6 counties had bilingual Spanish-speaking staff, these staff were not  specifically assigned to work with individuals applying for CCDF subsidies  but were clerical workers with other responsibilities. In most counties  visited, child care and Head Start centers had bilingual staff to help  parents with limited English proficiency enroll their children in the  programs. For example, an official in one child care center that we visited  where the majority of the families spoke Spanish said that all staff  responsible for enrolling families in the program spoke Spanish.
Several agencies that we visited also used telephone interpretation  services to provide oral assistance to clients with limited English  proficiency. For example, the subsidy administration offices that we  visited in Washington primarily used a state-contracted telephone  language line that connected agency staff with bilingual telephone  operators who could offer interpreting assistance in a language spoken by  the client. In an effort to help local agencies serve clients with limited  English proficiency in a cost-effective manner, North Carolina was in the  process of entering into a contract for a language line that would allow  local social service agencies, including those administering CCDF  subsidies, to provide oral language assistance to clients if bilingual staff  were not available on-site. A state official told us that once the contract is  awarded, the state will make the service available to all local social service  agencies at a reduced cost.
Several agencies also coordinated with one another to share resources for  offering oral language assistance. For example, to help interpret for their  Russian-speaking clients, a resource and referral agency in California with  language capacity in Cantonese and Mandarin coordinated with staff at  another nearby resource and referral agency that had language capacity in  Russian. Subsidy administration officials in one rural county that we  visited told us that the local hospital had a contract for the language line  and they coordinated with the hospital to make use of that service.  However, we did not find efforts to coordinate language assistance  strategies among agencies in some locations visited, and agency officials  in a few locations said that they could not always provide oral language  assistance to clients with limited English proficiency on their own.
The majority of agencies that we visited provided written language  assistance, such as translated subsidy application forms. Seven of the   11 subsidy administration offices contacted had subsidy applications  translated into Spanish. Local agencies in Washington, California, and  Illinois had applications that had been translated by the state. Washington  required its application for the child care subsidy to be translated into  eight languages, while California and Illinois made applications available  in Spanish and gave local agencies the option of translating materials into  other languages. Arkansas and North Carolina had no translated  applications at the time of our visits, although officials in North Carolina  said that the state was in the process of translating the subsidy application  into Spanish. All of the resource and referral agencies that we visited  translated materials into Spanish, such as brochures containing  information on how to receive child care assistance and what to look for  when choosing a provider. A few resource and referral agencies also made  efforts to translate written information into other languages. For example,  as shown in figure 4, one agency translated a brochure on child care  quality into Chinese. However, some state and local officials told us that  their offices lacked the resources to translate materials into other  languages.
The majority of local agency officials and providers that we interviewed  told us that they relied on agency staff and volunteers to translate  materials. For example, officials from a Head Start program told us that  their staff had translated materials about the program into Spanish,  Hmong, and Laotian. Officials at another Head Start program told us that  they relied on bilingual staff, parents of children enrolled in the program,  and Spanish-speaking volunteers from the community health clinic to  translate the materials. Some agency officials told us that they also used  outside contractors or other resources, such as commercially available  translation software, to translate materials. Community group  representatives expressed concerns about the quality of translations done  by the local agencies, particularly in instances when volunteers or  translation software had been used.
Most local agencies and providers that we interviewed said that they  disseminated translated information to raise awareness of their programs  and services among parents with limited English proficiency. Agencies and  providers employed various mechanisms to disseminate information,  including using print and radio media and direct distribution of  informational materials in the communities where many families with  limited English proficiency reside. For example, some resource and  referral agencies and providers said that they advertised their programs  and services on Spanish-language television and radio stations, and a few  agencies had placed advertisements in the Yellow Pages. Most of them  also reported distributing information in various locations in the  community, such as churches, neighborhood markets, and laundromats.
Despite these agencies’ various outreach efforts, mothers in focus groups,  many of whom were unaware of the available assistance, said that there  was a need for greater information dissemination in their communities.  Spanish- and Vietnamese-speaking mothers in all 12 focus groups  indicated that disseminating information in their language would help  them learn about child care assistance and child care and early education  programs for their children. At the same time, focus groups with Spanish- speaking mothers in California who were already receiving the subsidies  revealed their ambivalence about increased advertising of certain child  care programs because some of these programs already had waiting lists.  Some state and local officials also acknowledged that they did little or no  advertising because their programs were already operating at full capacity  or had substantial waiting lists.
section_title: Selected Agencies Took Steps to Increase the Supply of Providers Able to Communicate Effectively with Parents
paragraphs: Agencies in the majority of locations that we visited had initiatives to  increase the supply of providers who spoke other languages or to offer  training in other languages to existing providers. Some agencies had come  up with initiatives that focused on helping individuals speaking other  languages to enter the child care field. For example, one resource and  referral agency that we visited offered the classes required for obtaining a  child care license in Spanish, and another one offered them in Cantonese.  A resource and referral agency that we visited in an urban county  developed a program to help Somali- and Russian-speaking women in the  community obtain the training necessary to become licensed family child  care home providers. In four of the five states that we visited, officials told  us that selected community colleges participated in efforts to increase  provider capacity to serve children of parents with limited English  proficiency. For example, a community college in Illinois offered early  childhood education classes in Spanish, while a community college in  California coordinated with a local resource and referral agency to offer  these classes in Cantonese. However, some officials said that such efforts  were insufficient, and in one state visited, an official from a university  early childhood education program said that she was not aware of any  efforts in the state to offer classes in other languages.
Many agencies that we visited also provided training to existing child care  providers who had limited English proficiency. For example, local referral  agencies in Illinois included bilingual individuals in the technical  assistance teams available to assist providers in improving the quality of  care.
Three of the five states that we visited used CCDF quality funds for  various provider initiatives related to language, such as offering training to  providers on working with families that had limited English proficiency or  translating materials into other languages. For example, Arkansas used  quality funds for training and technical assistance to help providers  understand cultural issues that families with limited English proficiency  face. California used these funds to offer training to providers throughout  the state on working with children who speak other languages. Officials in  North Carolina said that while they did not have any projects funded with  CCDF quality funds that directly related to serving children of parents with  limited English proficiency, they had used some of the funds to translate  materials on child care health and safety practices into Spanish. Two of  the states visited—Washington and Illinois—did not use CCDF funds  directly on initiatives related to serving children of parents with limited  English proficiency or providers working with them. However, both states  used the funds to support other initiatives, such as the work of resource  and referral agencies, which included outreach to parents with limited  English proficiency in some of their efforts.
State and local officials told us that despite efforts made, there was a  shortage in some locations of training opportunities for providers who  speak other languages. For example, officials across states and counties  that we visited cited examples of child care providers with limited English  proficiency who had attended training, such as training required for  licensing, although they could not fully understand the course content  because it was not available in their languages. An official we interviewed  told us that this could affect the quality of child care they would offer to  children because the training covered critical issues, such as health and  safety procedures.
section_title: Officials in Selected State and Local Agencies Reported Challenges in Providing Services to Parents with Limited English Proficiency
paragraphs: State and local agency officials, providers, and community college  representatives reported several challenges associated with providing oral  language assistance to parents with limited English proficiency applying  for child care and early education programs for their children. Officials  told us they faced challenges providing oral language assistance because  of the difficulties that agencies had hiring qualified bilingual staff. Even  when qualified bilingual individuals were found, officials said that these  individuals were in very high demand and agencies could not always  compete with other organizations interested in hiring them. For example,  some child care and Head Start providers told us that they are losing  qualified bilingual staff to school districts that offer higher salaries. Rural  areas especially experienced difficulties hiring bilingual staff because their  pool of qualified candidates was smaller than in the cities or virtually  nonexistent. A few officials said that the lack of reliable transportation in  rural areas makes it difficult to recruit staff from the cities. For example, a  resource and referral agency official in one rural area that we visited told  us that her office’s bilingual staff had quit because they had difficulty  getting to work. Officials also cited difficulties with finding professional  interpreters and with the expense associated with hiring them when  agencies lacked bilingual staff of their own to offer oral language  assistance to clients.
Agency officials also reported challenges providing written language  assistance to parents with limited English proficiency. They said that  translating materials into other languages was expensive, particularly for  agencies that served clients from several different language groups and  had to translate materials into multiple languages. Local agencies  frequently relied on their own staff to translate the materials, but a few  officials said that this posed a burden on staff with other full-time  responsibilities. At the same time, state and local officials said that  contracting out for translations was expensive. Although state officials  acknowledged the expense associated with translating materials into other  languages, some states left local agencies to shoulder the burden of  translating documents on their own. For example, state officials in  California told us that the expense prevented the state from translating  applications into languages other than Spanish, but local agencies had  absorbed the cost of translating applications themselves in order to meet  the needs of program applicants who spoke other languages.
In addition, officials said that providing language assistance or training in  other languages was not always cost-effective because of the relatively  small number of individuals that would benefit from such efforts. For  example, one resource and referral agency official told us that the cost of  ordering materials in Spanish was higher than the cost of ordering the  same materials in English because the materials had to be purchased in  smaller orders, thereby increasing their cost. Some officials said that while  they were able to offer language assistance to larger language groups in  the area, such as Spanish speakers, they chose not to expand their  assistance to include other language groups because of the small number  of individuals that would benefit from it.
Despite challenges faced, agency officials that we interviewed expressed  the need for effective and affordable ways to provide services to  individuals with limited English proficiency. Officials in three states visited  told us that they would benefit from having additional information on cost- effective strategies to serve parents with limited English proficiency.  Several officials also told us that it would be helpful for them to learn  more about the professional development opportunities for providers  offered at other locations. For example, officials in Illinois said that the  state’s current capacity for provider training in Chinese was limited and  that they would like to learn more about any curricula developed in other  states with larger Asian populations.
section_title: HHS Provided Assistance to Grantees on Serving Children of Parents with Limited English Proficiency, but Gaps Remain in Its Program Review Efforts
paragraphs: HHS issued general guidance, translated materials, and provided technical  assistance to grantees on serving children of parents with limited English  proficiency, but gaps remain in its program review efforts. The Office of  Head Start has provided assistance to increase awareness of the Head  Start program among families with limited English proficiency and has  monitored local programs’ efforts to provide access to these families by  reviewing grantees’ biennial assessments of need in the communities they  serve and by conducting formal monitoring reviews of grantees. However,  an Office of Head Start official told us that the office could not ensure that  its review teams consistently reviewed grantee compliance with program  standards related to language access, and in our prior work we found that  no mechanism existed to ensure consistency in the monitoring process.  CCB provided assistance to help programs serve children whose parents  have limited English proficiency, as well as reviewed states’ CCDF plans  and investigated complaints. However, CCB had no mechanism for  reviewing how access to CCDF subsidies was provided for children of  parents with limited English proficiency or for ensuring that these children  were not inadvertently excluded from the subsidies as a result of state  eligibility criteria that were inconsistent with CCB’s program eligibility  guidance.
subsections: section_title: HHS Issued General Guidance to Grantees on Providing Access to Federal Programs for Individuals with Limited English Proficiency
paragraphs: In 2003, consistent with Executive Order 13166, HHS issued guidance to  federal financial assistance recipients regarding the Title VI prohibition  against national origin discrimination as it affects individuals with limited  English proficiency. The guidance was intended to help recipients of HHS  funds, such as agencies administering CCDF subsidies and Head Start  programs, provide meaningful access for individuals with limited English  proficiency. The guidance, however, applied to all HHS programs and did  not refer specifically to child care or early education.
HHS’ OCR provided outreach to potential beneficiaries of HHS programs  and offered technical assistance to grantees to help them comply with the  guidance. For example, OCR officials told us that they disseminated  information about serving individuals with limited English proficiency at  Hispanic health fairs, through recorded public service announcements and  interviews on Spanish-language media, and by giving presentations before  community service organizations. They also said that they provided  grantees with technical assistance in identifying appropriate language  access strategies. Regional OCR officials told us that their offices served  as a resource for local social service agencies, directing them to less costly  language access strategies, such as sharing interpreter services, and  providing information on available resources and practices.
OCR also participated in the Federal Interagency Working Group on  Limited English Proficiency that developed, among other things, a Web  site devoted to serving persons with limited English proficiency  (www.lep.gov). The Web site serves as a clearinghouse, providing  information, tools, and technical assistance regarding limited English  proficiency and language services for federal agencies, recipients of  federal funds, users of federally assisted programs, and other interested  parties. It makes available a range of guidance and information on offering  language assistance through mechanisms such as interpreter services and  translated materials for clients with limited English proficiency in the  areas of health care, the courts, and transportation. However, it does not  include specific information on providing language assistance in child care  and early education programs. In addition, CCB and Office of Head Start  officials and officials from several HHS regional offices told us that they  were unaware of the Web site.
OCR is required to investigate all complaints of alleged discrimination,  including lack of access to programs for individuals with limited English  proficiency. OCR officials told us that Title VI violations in child care were  rare. They said that when infractions do occur, they try to reach a  voluntary compliance agreement with the state and conduct follow-up to  ensure that the state takes corrective action to comply with the terms of  the agreement. For example, North Carolina entered into a voluntary  compliance agreement with OCR and implemented a corrective action  plan for providing access for program applicants with limited English  proficiency. A state official told us that the state was in the process of  translating the subsidy application into Spanish as a result of this  agreement.
section_title: The Office of Head Start Provided Assistance to Increase Awareness of Head Start and to Improve Service Delivery and Conducted Limited Monitoring of Language Access in Head Start Programs
paragraphs: The Office of Head Start has provided a variety of assistance to increase  awareness of the Head Start program among families with limited English  proficiency. The office has twice hosted a National Head Start Hispanic  Institute, the goals of which included improving outreach to Hispanic  communities, developing methods to effectively serve Hispanic children  and families, and helping ensure positive outcomes in language and  literacy development for English-language learners. A Head Start official  told us that the needs of other language groups needed to be addressed as  well, and that the Office of Head Start was considering how to replicate  the institute for groups that speak other languages. According to officials,  the Office of Head Start has several other initiatives to reach parents with  limited English proficiency, such as placing public service announcements  on Spanish-language media and distributing a brochure in Spanish  informing families potentially eligible for Head Start of the benefits of  enrolling their children in Head Start.
The Office of Head Start has also provided assistance to grantees to better  serve children of parents with limited English proficiency. Recently, the  office conducted a national language needs assessment of second  language and dual language acquisition to identify culturally responsive,  research-based strategies to improve outcomes for children and families.   It also developed a Culturally Responsive and Aware Dual Language  Education (CRADLE) training initiative that is designed to support  grantees in their efforts to find best practices for language acquisition for  the birth-to-3-year-old population. In addition, through its English  Language Learners Focus Group, the Office of Head Start created  materials for grantees working with second language learners, including  Spanish speakers who constitute the majority of children in Head Start  whose parents have limited English proficiency.
The Office of Head Start monitors grantees’ efforts to provide access for  individuals with limited English proficiency by reviewing their biennial  community assessments and conducting formal on-site monitoring  reviews. Head Start programs are required to conduct a community  assessment at least once every 3 years, and the Office of Head Start  regional officials review these assessments for demographic disparities  between program participants and the population of the community to be  served. For example, programs with assessments showing large numbers  or proportions of language groups in the community that are not reflected  in the enrollees or the classroom teachers may be found out of compliance  with meeting local needs. Head Start programs are also monitored by the  Office of Head Start once every 3 years through the PRISM process. Head  Start programs are required to adhere to program performance standards  that define the services that programs are to provide to children and their  families, and on-site PRISM review teams monitor Head Start grantees’  adherence to the standards. Several of the standards directly address  interactions with children and parents with limited English proficiency.  For example, one performance standard requires communications with  parents to be carried out in the parent’s primary or preferred language or  through an interpreter. Another performance standard directs programs  in which the majority of children speak the same language to have at least  one classroom staff member or home visitor who speaks that language.  The contractor responsible for assigning bilingual reviewers to PRISM  review teams told us that about 17 percent of reviewers were bilingual and  that review teams requesting a Spanish-speaking bilingual individual had  one assigned 70 percent of the time.
A Head Start official with responsibility for the PRISM process told us that  given the vast number of regulations, however, it was impossible to ensure  that all of them were consistently reviewed in the course of a 1-week  review. In our previous work, we reported that ACF had no process in  place to ensure that its reviewers consistently followed the standards  while conducting on-site PRISM reviews. We recommended that ACF  develop an approach that can be applied uniformly across all of its  regional offices to assess the results of the PRISM reviews and implement  a quality assurance process to ensure that the framework for conducting  on-site reviews was implemented as designed. HHS agreed with our  recommendation, and Head Start officials indicated that the Office of Head  Start was developing new PRISM protocols and training reviewers to add  more uniformity to how grantees are assessed. In addition, the Office of  Head Start recently announced plans to conduct follow-up reviews of  grantees monitored through the PRISM system in an effort to ensure that  PRISM review teams did not miss grantee deficiencies, such as in  providing assistance to children and parents with limited English  proficiency.
section_title: CCB Provided Assistance to Help CCDF Programs Serve Children Whose Parents Have Limited English Proficiency but Had No Mechanism for Reviewing Agencies’ Provision of Access
paragraphs: CCB provided assistance to raise program awareness among parents with  limited English proficiency whose children may be eligible for CCDF  subsidies. Officials told us that CCB had translated a number of its  consumer education materials into Spanish, including the CCDF program  brochure and public service announcements informing parents where and  how to locate child care. In a targeted effort to reach Hispanic families and  providers, CCB also translated into Spanish a brochure outlining what  providers should know about child care assistance for families. CCB,  through a cooperative agreement with the National Association of Child  Care Resource and Referral Agencies (NACCRRA), provides educational  information to parents through the Child Care Aware Web site  (www.childcareaware.org). In addition, NACCRRA has translated  consumer education publications into Spanish, including a publication on  paying for child care, which it made available through its Web site to  resource and referral agencies nationwide. CCB officials told us that they  were also looking into translating these publications into Chinese. CCB  also sponsors a National Child Care Information Center Web site  (www.nccic.org), which offers information on a wide range of child care  issues, including a number of documents that relate to serving children  from families with limited English proficiency.
CCB officials told us that they provided opportunities for agencies and  providers to share information, including information on serving children  of parents with limited English proficiency. For example, CCB convened  meetings of state CCDF administrators that, while not focusing specifically  on issues of limited English proficiency, covered topics such as meeting  the needs of diverse groups of children and parents. In addition, CCB  maintains an online forum for states to pose questions and share ideas,  which has been used to discuss such issues as converting print materials  into Spanish. CCB also offers child care providers online access to training  modules, practical strategies for serving children and families, and  interactive online chats in English and Spanish through the Center on  Social and Emotional Foundations for Early Learning Web site  (www.csefel.uiuc.edu).
While it has made efforts to assist states with serving the needs of children  whose parents have limited English proficiency, CCB has no mechanism  for reviewing how agencies provide access to CCDF subsidies for eligible  children of parents with limited English proficiency or ensuring that these  children are not inadvertently excluded as a result of state CCDF eligibility  criteria that are inconsistent with agency guidance. CCB officials told us  that CCDF is a block grant and CCB receives no funding specifically for  supporting monitoring activities. As a result, CCB’s oversight of CCDF is  limited to reviewing states’ CCDF plans and investigating complaints.  CCB, however, does not require states to include assurances in their CCDF  plans that state agencies are providing access to CCDF subsidies for  children of parents with limited English proficiency. Regional officials told  us that they had complaint processes in place and would either review  complaints or refer them to OCR, but said that they were unaware of any  complaints regarding restricted access for individuals with limited English  proficiency. Officials in one region told us that states appeared to  understand the CCDF program eligibility criteria. Officials in another  region told us that while they interacted with states through phone calls  and occasional on-site visits, these contacts primarily focused on the  provision of technical assistance. Thus, these interactions were not a  systematic review of how states determine eligibility for federal child care  assistance.
On our site visit to Arkansas, we found that the state had eligibility  requirements that appeared to violate CCB guidance. Specifically,  although guidance to state agencies administering CCDF clarified that only  the citizenship and immigration status of a child was relevant when  determining the child’s eligibility for federal child care assistance,  applicants for child care assistance in Arkansas had to submit a  declaration that the applicant (typically a parent applying to receive  assistance for the child) and all the other members of the household were  U.S. citizens, nationals, or legal residents. In addition, the state’s policy  manual for the administration of CCDF services indicated that the state  would deny any applications for child care assistance that were submitted  by parents or custodians who were neither citizens nor lawfully admitted  residents. These requirements have the potential of precluding children  who otherwise met the eligibility criteria from receiving federal financial  assistance on the basis of their parents’ citizenship or immigration status.
CCB officials told us that they were unaware of the situation until we  brought it to their attention and that they were in the process of discussing  with state officials how to resolve it. They further noted that they would  investigate formal complaints brought to their attention, which would  include complaints about states requesting unnecessary information on  their child care subsidy applications and adversely affecting individuals  with limited English proficiency. However, officials indicated that they had  received no such complaints from affected parties.
section_title: Conclusions
paragraphs: Access to high-quality child care and early education programs helps  promote healthy development of children and can provide an important  support for parents as they pursue employment or education to secure the  family’s economic well-being and avoid public assistance. The resources  available for nonentitlement child care and early education programs,  such as CCDF subsidies and Head Start, are limited and not intended to  cover everyone who meets eligibility criteria and is in need of assistance.  Consequently, agencies have to make choices about who they will cover  with the limited funds, employing strategies such as prioritization of  certain groups of applicants or waiting lists. At the same time, federal,  state, and local entities play important roles in ensuring that parents’  language ability does not preclude children from being considered for  coverage under these programs.
These roles are becoming especially important as the demographics of  many communities are changing rapidly and localities across the country  are seeing increased numbers of individuals with limited English  proficiency. While state and local agencies are making efforts to address  the needs of this growing population, they experience difficulties offering  language assistance to parents seeking to access programs for their  children and recruiting new providers with the language ability to serve  these families. However, without reliable data on who is enrolled in their  programs, state and local officials may have difficulty determining the  extent to which parents with limited English proficiency have access to  these programs for their children and whether services need to be  adjusted to accommodate changes in the population served.
Although Congress provided states with flexibility in administering their  CCDF program grants, HHS is responsible for ensuring that states adhere  to the conditions of their grants and that they take reasonable steps to  ensure access to individuals with limited English proficiency. Yet, HHS’s  existing methods for reviewing how CCDF funds are used by grantees do  not systematically assess how access for parents with limited English  proficiency is provided or identify state or local policies that may  adversely affect these parents’ ability to access programs for their  children. HHS responds to complaints of any alleged discrimination or  agency actions that adversely affect the ability of eligible children to  access programs and services. However, HHS may lack the tools to ensure  equal access for children whose parents have limited English proficiency if  the parents do not bring complaints for reasons such as language  difficulties, unfamiliarity with how the complaint process works, or fear  about approaching government agencies. Without a mechanism to  systematically review access to CCDF-funded programs for these families,  HHS cannot provide all eligible children with the same opportunity to  participate in programs that would benefit them and their families and  possibly enhance their households’ self-sufficiency.
section_title: Recommendations for Executive Action
paragraphs: To help state and local agencies plan for language assistance and assess  whether they provide meaningful access to eligible children, regardless of  their parents’ English ability, we recommend that CCB work with states to  help them explore cost-effective strategies for collecting data on CCDF  subsidy recipients’ language preference or English proficiency and  comparing these data with available information on community  demographics. Once these data are available, HHS may consider collecting  information on existing cost-effective ways for agencies to provide  language assistance and to recruit providers who speak other languages,  as well as disseminating this information in the locations where the data  show the greatest need.
To provide opportunities to parents with limited English proficiency to  access federal child care subsidies for their children, we recommend that  HHS develop and implement specific steps to review whether and how  states provide access to CCDF programs for eligible children of parents  with limited English proficiency, as well as provide information to help  states evaluate their progress in this area. Specifically, HHS should  revise the CCDF plan template to require states to report on how  they will provide meaningful access to parents with limited English  proficiency seeking CCDF subsidies for their children, and    systematically review states’ program eligibility criteria for CCDF  subsidies to ensure that states comply with HHS policies related to  participation by children of parents with limited English  proficiency.
section_title: Agency Comments and Our Evaluation
paragraphs: ACF provided written comments on a draft of this report, which are  reproduced in appendix III. In its letter, ACF agreed with most aspects of  our recommendations and provided information on its actions or plans  that would support their implementation. In addition, ACF provided a  number of technical comments that we incorporated as appropriate.
In response to our recommendation that HHS work with states to help  them explore cost-effective ways of collecting data on the primary  language of CCDF subsidy recipients, ACF provided some additional  information on actions it has taken to help states in this area.  For  example, it stated that in July 2006, CCB launched a technical assistance  initiative that will, among other things, disseminate information to states  on effective strategies to assist families with subsidy access, including  families experiencing language barriers.
Regarding our second recommendation, that HHS develop a mechanism to  review how states provide access to CCDF subsidies for children of  parents with limited English proficiency, ACF indicated that it will  examine the feasibility of using the CCDF plan template to ask states to  report on their efforts to promote access to these families. However, ACF  did not address our recommendation that HHS systematically review  states’ eligibility criteria for CCDF subsidies to ensure that states comply  with HHS policies related to participation by children whose parents have  limited English proficiency.
ACF also submitted detailed comments related to our analysis of national  survey data collected in 1998 as part of ECLS-K. ACF noted that ECLS-K  data only provide information on children in the year before kindergarten  and that the analysis omits other variables that may explain our findings,  such as preferences for certain types of care within ethnic communities  and parents’ immigration status. Our report discusses these data  limitations, and as is the case with any statistical model, some of the  factors with the potential to affect the outcomes we examined could not  be included because the data measuring them were not collected. It is  partly for that reason that we employed multiple methodologies in  addressing our research objectives, including site visits and focus groups.
ACF noted that the data represent child care and early education patterns  for 1997 and that subsequent policy changes or increases in federal and  state child care funding, may have narrowed the gap in program  participation among different groups of children. However, we found that  some of the policy changes ACF cited were not consistently implemented  and ACF provided no more current data that would allow us to ascertain  the effects of these changes. As such, ECLS-K remained the most recent  national dataset that allowed us to compare children of parents with  limited English proficiency and similar children whose parents are  proficient in English with respect to their receipt of financial assistance  for child care from a social service or welfare agency and their  participation in Head Start.
As arranged with your office, unless you publicly announce its contents  earlier, we plan no further distribution of this report until 30 days after the  date of this letter. At that time, we will send copies of this report to the  Secretary of HHS, relevant congressional committees, and other interested  parties. We will also make copies available to others upon request. In  addition, the report will be made available at no charge on GAO’s Web site  at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-7215. Other contacts and major contributors are listed in  appendix IV.
section_title: Appendix I: Scope and Methodology
paragraphs: In conducting our work, we employed multiple methodologies, including a  review of available data on participation of children in child care and early  education programs, state and county site visits, focus groups with  mothers who have limited English proficiency, interviews with federal  officials and national experts, and a review of available legislation,  guidance, and other federal resources. We performed our work in  accordance with generally accepted government auditing standards  between July 2005 and June 2006.
subsections: section_title: Analysis of National Program Participation Data and State Data Inquiries
paragraphs: To obtain information on the participation of children whose parents have  limited English proficiency in child care and early education programs  funded through the Child Care and Development Fund (CCDF) and Head  Start, we obtained and reviewed the most recent program participation  data from the U.S. Department of Health and Human Services (HHS),  surveyed states about their data on CCDF subsidy recipients, and analyzed  national survey data available through the Early Childhood Longitudinal  Study, Kindergarten Class of 1998-99 (ECLS-K). The relevant  characteristics of data sources we examined are shown in table 1.
We reviewed CCDF program participation data collected by CCB in the  reports that states are required to submit on CCDF subsidy recipients but  found that these reports did not contain any data related to language from  CCDF subsidy recipients or their families. CCB officials confirmed that  they do not currently collect any language data, since such data collection  was not listed in the CCDF authorizing legislation.
We reviewed language data for Head Start participants available from the  Office of Head Start through the Head Start National Reporting System  (HSNRS) and the Head Start Family and Child Experiences Survey  (FACES). HSNRS, implemented in August 2003, is the nationwide skills  test of over 400,000 children aged 4 and 5 in Head Start, intended to  provide information on how well Head Start grantees are helping children  progress. The Computer-Based Reporting System (CBRS) was developed  for HSNRS to allow local Head Start staff to enter descriptive information  about their programs, including the demographic characteristics of  children assessed by HSNRS. We requested and reviewed HSNRS  demographic data from spring 2005 that provided information on the  primary language of children in Head Start. FACES is a series of  longitudinal surveys of nationally representative samples of children in  Head Start. We requested and reviewed fall 2003 FACES data, which  included about 2,400 parent interviews that provided information on the  languages spoken at home by Head Start families, parents’ self-reported  English proficiency, and the availability of Head Start staff to  communicate with children and parents in their preferred language.
To assess the reliability of Head Start data, we interviewed relevant HHS  officials and officials from Westat, a private research corporation  administering and analyzing HSNRS and FACES under a contract with the  Office of Head Start. In addition, we reviewed relevant documentation and  examined the logs of the computer code used to generate the data  provided to us. Because HSNRS data were collected only for 4- and   5-year-old children in Head Start, they cannot be used to generalize about  all children in Head Start. The HSNRS data were entered into CBRS by  the staff of local Head Start programs. While we did not independently  verify these data, we did not find any evidence to suggest that they were  unreliable. As part of FACES, interviews were held directly with parents of  children in Head Start. While Spanish interviewers were available, parents  with limited English skills who spoke other languages were required to  provide their own interpreter. Parents unable to participate in an interview  in English or Spanish or provide their own interpreters could not be  included in the survey. According to a Westat official, however, only three  interviews could not be conducted because of the lack of an interpreter.  We determined that FACES data were sufficiently reliable for the purposes  of this report.
Because the available agency data did not allow us to determine the total  participation of children of parents with limited English proficiency in  federal child care and early education programs, we also analyzed survey  data provided by NCES from ECLS-K, a national longitudinal study  focusing on following children’s early education and school experiences  from kindergarten through 12th grade. We used data from the fall 1998  base year survey of approximately 18,000 parents with children in  kindergarten. ECLS-K was the most recent national dataset that allowed us  to compare child care, financial assistance for child care, and Head Start  usage rates among children with parents who had limited English  proficiency and children whose parents were proficient in English.  Among other topics, ECLS-K asked parents about their English  proficiency, the languages spoken at home, their child’s use of child care  in the year before kindergarten, any financial assistance from a social  service or welfare agency, and the child’s use of Head Start. The survey  did not ask for the specific social service or welfare agency providing  financial assistance for child care, so we were unable to make estimates  about the use of CCDF subsidies from this dataset. NCES had bilingual  interviewers available to conduct the survey in Spanish, Chinese, Hmong,  and Lakota if the respondent was not able to speak English and no  English-speaking member of the household was available. Slightly more  than 7 percent of the interviewers were conducted in a language other  than English. More information about our analysis of ECLS-K data can be  found in appendix II.
To assess the reliability of ECLS-K data, we reviewed relevant information  about the survey, including the user manual, data dictionary, and steps  taken to ensure the quality of these data, and performed electronic testing  to detect obvious errors in completeness and reasonableness. We  determined that the ECLS-K data were sufficiently reliable for the  purposes of this report.
We also contacted child care administrators in all 50 states and the District  of Columbia to determine whether any states collected their own data on  the language of CCDF subsidy recipients. We discussed data collection  with officials in 5 states in the course of our site visits and contacted  officials in the remaining 45 states and the District of Columbia by e-mail.  Of those contacted by e-mail, 40 states and the District of Columbia  responded. Overall, 12 states and the District of Columbia collected some  language data from parents whose children received CCDF subsidies. We  then followed up with officials in the District of Columbia and all 12 states  that reported collecting the data on the language of CCDF subsidy  recipients to ask questions about the type of data collected, the methods  by which the data were collected, the challenges states faced in collecting  the data, and the purposes for which the data were used. We did not ask  states to submit their data to us because we determined that the  differences in states’ data collection approaches and the limitations of  state data would preclude us from aggregating state data to produce  national estimates of CCDF subsidy use among children of parents who  speak other languages.
section_title: Site Visits
paragraphs: To obtain information on the challenges that parents with limited English  proficiency face in accessing CCDF subsidies and Head Start and the  assistance provided to these families by state and local entities, we visited  5 states—Arkansas, California, Illinois, North Carolina, and Washington.  We selected these states on the basis of the size and growth of their  population of individuals with limited English proficiency as determined  by our analysis of 1990 and 2000 data from the U.S. Census Bureau, the  states’ geographic location, and the presence of initiatives focused on  individuals with limited English proficiency as determined by our review  of CCDF plans that states are required to submit to CCB every 2 years. We  visited 10 counties across these states, as well as contacted officials in   1 county by telephone. We selected counties with substantial numbers of  individuals with limited English proficiency or that have experienced a  significant growth in this population based on the analysis of 1990 and  2000 U.S. Census data. (See table 2.) In choosing counties, we also  considered the proportion of residents living in urban and rural parts of  the county to obtain information on the experiences of families in both  urban and rural areas.
On each site visit, we interviewed various stakeholders in the child care  and early education field at the state and local levels, including officials  responsible for administering CCDF subsidies, representatives of child  care resource and referral agencies, Head Start officials, and child care  and early education providers, as well as officials from community  organizations and advocacy groups working with individuals who have  limited English proficiency.
section_title: Focus Groups
paragraphs: To obtain information on the challenges that parents with limited English  proficiency face when accessing child care subsidies for their children, we  conducted 12 focus groups with mothers who had limited English  proficiency in California, Washington, and North Carolina. We selected  these locations in order to include both states with historically large  populations of individuals with limited English proficiency (California and  Washington) and a state experiencing a more recent growth in this  population (North Carolina)—based on our analysis of data from the U.S.  Census. GAO contracted with Aguirre International, a firm specializing in  applied research with hard-to-reach populations, to recruit focus group  participants through community-based organizations, arrange facilities for  focus groups in locations familiar and accessible to the participants,  provide transportation to and from child care during the focus groups,  moderate the group discussions, and translate focus group transcripts.  Focus groups were conducted from January 2006 to March 2006.
Consistent with focus group data collection practices, our design involved  multiple groups with certain homogeneous characteristics. All focus  groups were conducted with mothers of children aged 5 or younger  enrolled in child care. These mothers also had limited English proficiency  as self-reported by potential participants during the focus group  recruitment process and were eligible for CCDF subsidies as determined  by family’s income and parental work and education activities. The focus  groups varied by primary language spoken and whether or not  participants’ children were receiving government child care subsidies.  Eight of the 12 focus groups were conducted in Spanish and 4 in  Vietnamese. We chose to conduct focus groups in Spanish and Vietnamese  because these two languages were among the most prevalent languages,  other than English, spoken in the states of interest. According to 2000  Census data, Spanish was the language most commonly spoken among  these households in the states we visited. In Washington, Vietnamese was  the most commonly spoken language after Spanish, and in California,  Vietnamese was the second most commonly spoken language after  Spanish. We did not conduct focus groups in Vietnamese in North Carolina  because of the limited number of individuals who spoke languages other  than English or Spanish in the state. Six of the focus groups consisted of  mothers with young children (ages 0-5) who were enrolled in child care  and received a government subsidy for that care; the other 6 groups  consisted of mothers with young children (ages 0-5) who were enrolled in  child care and did not receive a government subsidy for that care, but  whose children likely qualified for subsidies based upon their family’s  income and employment or education activities. Table 3 describes the  characteristics of the group at each location and lists locations and dates  for each focus group conducted. The number of participants in each focus  group ranged from 6 to 13.
To help the moderator lead the discussions, GAO developed a guide that  included open-ended questions related to mothers’ experiences finding  appropriate child care and attempting to access financial assistance to  help pay for the care. Discussions were held in a structured manner and  followed the moderator guide.
Focus groups involve structured small group discussions designed to gain  in-depth information about specific issues that cannot easily be obtained  from single or serial interviews. Methodologically, they are not designed to  provide results generalizable to a larger population or provide statistically  representative samples or reliable quantitative estimates. They represent  the responses only of the mothers who participated in our 12 groups. The  population of individuals with limited English proficiency in the United  States consists of many cultural backgrounds and languages in addition to  Spanish and Vietnamese, and those and other factors may influence the  experience and attitudes of parents with limited English proficiency  regarding child care. Therefore, the experiences of other mothers may be  different from those of focus group participants. In addition, while the  composition of the groups was designed to include different states,  languages, and subsidy participation status, the groups were not random  samples of mothers with limited English proficiency.
section_title: Other Methodology
paragraphs: To assess HHS’s efforts to ensure access to its programs for parents with  limited English proficiency, we interviewed HHS officials, reviewed  documents and guidance produced by HHS for state and local grantees,  and analyzed relevant legislation. We interviewed officials from CCB, the  Office of Head Start, HHS’s Office for Civil Rights, and the five HHS  regional offices that covered the states that we visited. We also reviewed  informational materials produced by HHS to facilitate access to programs  for individuals with limited English proficiency and online resources  pertaining to language access that were available through HHS’s and the  Department of Justice’s Web sites. Additionally, we analyzed relevant  legislation, federal regulations, and reports from research organizations.
Finally, to obtain information pertaining to our research objectives, we  interviewed officials from various national organizations working on  issues related to early child care and education, as well as organizations  advocating on behalf of individuals with limited English proficiency.
section_title: Appendix II: Analyses of the Effects of Limited English Proficiency on Child Care and Early Education Patterns
paragraphs: We analyzed national survey data collected in 1998 as part of the Early  Childhood Longitudinal Study, Kindergarten Class of 1998-99 (ECLS-K)  from parents of kindergarten children about their children’s experiences in  the year before kindergarten. To conduct our analyses, we used logistic  regression models to estimate the “net effects” of the parent’s limited  English proficiency on children’s child care and early education patterns.  We defined parents as having limited proficiency in English if the parent  participating in the interview reported that a language other than English  was spoken at home, and if the respondent him or herself reported  speaking English either “not very well” or “not well at all.” We made this  decision because we surmised that speaking is one of the main channels  through which information about child care is communicated.  Additionally, we made the decision to focus on the English language  ability of the parent participating in the interview on the assumption that  the respondent participating in the survey about his or her child would  have a primary role in child care decisions.
We considered the effect of the parent’s limited English proficiency on  four outcomes. First, we looked at the effect it had on the likelihood of  their child receiving any type of nonparental child care in the year before  the child was in kindergarten, regardless of whether the care was provided  in a child care center (including a prekindergarten program) or by  relatives or nonrelatives in some other setting. Second, we looked at the  effect that limited English proficiency had on the likelihood of receiving  financial assistance from a social service or a welfare agency to help pay  for child care among those who did receive child care. Third, we looked at  the effect that limited English proficiency had on the likelihood that the  child care provided was in a center-based facility (rather than care  provided by relatives or nonrelatives) because it has been suggested that  children whose parents have limited English proficiency may be less likely  to receive center-based care than other children. Fourth, and finally, we  considered whether limited English proficiency affected the likelihood of  participating in Head Start.
By “net effects,” we mean the effects of limited English proficiency that  operate after we control for other factors that affect these different  outcomes and that are related to limited English proficiency. The most  obvious among these other factors is race or ethnicity. That is, the  probability of using any nonparental care, receiving financial assistance  for child care, having center-based care rather than some other form of  care, and participating in Head Start are different among racial and ethnic  groups, and English proficiency is vastly different for some groups,  particularly Hispanics and Asians, than for whites and other races. As  such, after looking at the difference between children of parents with  limited English proficiency and other children on these outcomes, we used  multivariate logistic regression models to re-estimate this difference when  controlling for the effect of characteristics such as the child’s race or  ethnicity. The other characteristics we controlled included household  income (because of its effect on eligibility for some child care assistance  programs and Head Start) and parental education(because previous  studies have shown it to have an effect on participation in child care and  early education programs). We also controlled for the number of persons  over 18 in the household and whether the parent or parents in the house  were employed because these can affect the availability of care givers in  the home and determine the need for child care and child care assistance  outside of the home. Another reason why we controlled for parental  employment status is that it is one of the factors considered for CCDF  eligibility. When we looked at the likelihood of receiving any care or  receiving that care in a center-based facility, as well as at the likelihood of  receiving financial assistance for care received, we controlled for whether  the family participated in Head Start, since we surmised this may affect  whether additional child care was needed. Additionally, because we  thought that being in multiple types of child care may affect the likelihood  of one of them being provided in a center-based facility or being  subsidized by an outside source, we also controlled for whether the child  received multiple types of child care when we looked at the likelihood of a  child being in center-based care or receiving financial assistance for child  care. Finally, when we looked at whether financial assistance was  received for the care, we controlled for whether the care was provided in a  center-based facility on the assumption that the cost of care may be higher  when it is provided in a formal center-based setting. Additionally, other  factors, such as family preferences for a certain type of care and parents’  immigration status, as well as changes in the CCDF program and child  care policies within a particular state of residence may affect child care  and early education patterns of children. We partially mitigated the  potential effect of preferences for certain types of care on the receipt of  financial assistance for child care by controlling for whether or not the  child was in center-based care. However, we could not include all factors  that may have had an effect on the outcomes in the analysis because the  ECLS-K did not collect the data to measure them.
An understanding of how to interpret the results of these multivariate  logistic regression models is facilitated by first considering tables 4 and 5,  which estimate the effects of limited English proficiency, and race or  ethnicity, on the first two of these four outcomes. Tables 4 and 5 estimate  how English proficiency and race or ethnicity are related to receiving any  nonparental child care and to receiving financial assistance for child care  (among those who received any nonparental child care). It is important to  note that these estimates are unadjusted for other characteristics that are  related to these outcomes, such as education, income, and employment  status. The top section of tables 4 and 5 shows the effect of parents’  limited English proficiency on the two outcomes, the middle section  shows the effect of the child’s race or ethnicity, and the bottom section  shows the joint effect of the two, or the effect of limited English  proficiency within each racial or ethnic category. We show these effects in  each section of the tables by first providing percentages of children of  parents with limited English proficiency and other children having a  certain outcome. We then calculate odds and odds ratios for the likelihood  of children within each of the two groups having these outcomes. Odds  and odds ratios are the measures used to describe effects that underlie the  logistic regression models we later employ to estimate net effects of  limited English proficiency while controlling for other factors.
Consider table 4, which provides percentages, odds, and odds ratios  related to the differences in receiving any type of child care across  children that differ by their parents’ English proficiency, their race or  ethnicity, and both. We see in the top section that while approximately   75 percent of children whose parents are English proficient received some  form of child care in the year preceding kindergarten, the same is true of  only 46 percent of children whose parents have limited English  proficiency. These percentages are derived from weighted data in our  sample that take account of the fact that we are working with a sample  that is not a simple random sample (where all individuals have an equal  chance of being selected), but one in which children in some groups,  namely Asians and Pacific Islanders, were oversampled. They are based,  however, on the unweighted number of cases in our sample of   18,033 respondents (16,784 of them with parents proficient in English and  1,249 with parents with limited English proficiency), given in the third  column of the table. The difference in these two percentages is sizable,  and statistically significant, and would lead us to conclude that children of  parents with limited English proficiency are less likely to receive  nonparental care of any form.
An alternative way to look at this difference is by calculating the odds of  receiving child care, which is the percentage of children who receive child  care divided by the percentage of children who do not. In the case of  children of parents that are English proficient, these odds are   74.8/25.2 = 2.97, which implies that in that group, approximately 3 families  use child care for every family that does not (or that 300 families do for  every 100 families that do not). In the case of children of parents that are  not English proficient, these odds are 45.6/54.4 = 0.84, which implies that  for them, approximately 0.8 families use child care for every family that  does not (or that 80 families do for every 100 that do not). The ratio of  these two odds, or 0.84/2.97 = 0.28, tells us that the odds on receiving any  care are decidedly lower for children of parents with limited English  proficiency than for children of parents that are English proficient, by a  factor of 0.28.
The middle section of table 4 shows the differences in the percentages and  odds of children receiving child care across racial or ethnic categories.  The percentages of children receiving child care in the year before  kindergarten are lower for minority children than for whites, and these  differences are reflected in the odds as well. Among white children, about  3.6 children received child care for every child that did not, while among  blacks and Asians approximately 2.4 children received child care for every  child that did not. Among Hispanics, approximately 1.5 children received  child care for every child that did not. Where variables have more than two  categories, such as different categories of race and ethnicity, we chose one  category as the reference category and calculated odds ratios that reflect  how different each of the other categories is relative to that one. In this  case, whites were chosen as the reference category, and the odds ratios of  0.67, 0.42, 0.66 and 0.54 indicate how much lower the odds of receiving  child care were for blacks, Hispanics, Asians, and other races,  respectively, than for whites.
The bottom section of table 4 shows the differences in the percentages of  children receiving any child care across the joint (or combined) categories  of parents’ English proficiency and the child’s race or ethnicity. Here we  have calculated odds for each of the joint categories, and the odds ratios,  which indicate how different the odds are across English proficiency  categories, within each category of race or ethnicity. We can see that  within most categories of race or ethnicity, children of parents with  limited English proficiency have lower odds of receiving any child care  than children of parents that are proficient in English, by factors such as  0.38 for Hispanics and 0.40 for Asians. The odds ratios for whites, blacks,  and others were based on very small numbers of children of parents with  limited English proficiency. Of the 1,249 children of parents with limited  English proficiency, only 34, 10, and 8 children are white, black, and other,  respectively, and these numbers are too small for us to assess whether and  how much they differ from children of parents that are proficient in  English.
In sum, table 4 indicates that children of parents with limited English  proficiency were less likely to receive any child care than children of  parents proficient in English. Some of this is due to the fact that children  of parents with limited English proficiency tend to be Hispanic and Asian,  groups that are less likely than whites to receive child care. However, not  all of it is due to race or ethnicity differences, since among Hispanics and  Asians the children of parents with limited English proficiency were less  than half as likely as others within the same racial or ethnic group to  receive any child care.
Table 5 provides similar information with respect to the likelihood of  receiving financial assistance for child care, among those children that  received any care. Overall, children of parents with limited English  proficiency were less likely than those with parents proficient in English  to receive financial assistance (odds ratio = 0.60), though most racial or  ethnic minorities, except for Asians, were more likely than whites to  receive financial assistance when they received some type of care. That is,  while Hispanic children were twice as likely as white children to receive  financial assistance, and blacks and other races were approximately four  times as likely, Asians’ odds of receiving financial assistance were not  statistically distinguishable from those of whites (odds ratio = 0.70).  Further, in the two groups—Hispanics and Asians—that had sizable  numbers of children of parents with limited English proficiency, the effect  of limited proficiency was different. Among Hispanics, the odds of  receiving financial assistance were lower for children of parents with  limited English proficiency than for children of parents that were  proficient in English (odds ratio = 0.46), while among Asians the odds of  receiving financial assistance were not statistically distinguishable  between children of parents with limited English proficiency and children  of parents that were proficient in English (odds ratio = 1.95). Among the  other groups, the numbers of children of parents with limited English  proficiency who received child care in the year prior to kindergarten were  too small for us to be able to reliably detect any difference between them  and others in the likelihood of receiving financial assistance.
The tables above showed the gross or unadjusted differences in receiving  child care and receiving financial assistance for child care between  children of parents with limited English proficiency and children of  parents proficient in English, and what those differences look like when  we control for or take account of race or ethnicity, the factor with which  parents’ limited English proficiency is most closely associated. However,  limited English proficiency is associated with a number of other factors  that affect these two outcomes, as well as the other two outcomes that  were of interest to us, which were the likelihood of receiving center-based  care (as opposed to care from relatives or nonrelatives in some other  setting) and the likelihood of participating in Head Start. Tables 6 through  9 show that the percentages of children that are Hispanic or Asian, from  lower-income families, have less educated parents, and have three or more  persons in the household over the age of 18 are higher among children of  parents with limited English proficiency than among other children.  Tables 10 and 11 show that the percentage of children that have their  parent (in single parent households) or both parents working and the  percentage of children that receive multiple types of care are lower among  children of parents with limited English proficiency than among other  children.
In tables 12 through 15 we show what the adjusted effect of parents’  limited English proficiency is on the likelihood of their child (1) receiving  any nonparental child care, (2) receiving financial assistance for child  care, (3) receiving center-based care, and (4) participating in Head Start,  when we estimate its effect using logistic regression models to control for  the effects of the other factors. In the first two columns of each table, we  show the unadjusted effect of parents’ limited English proficiency on each  outcome across all racial/ethnic groups, and what the adjusted effect looks  like when we control for race or ethnicity and other factors. In the third  and fourth columns of each table, we show the unadjusted and adjusted  effect of parents’ limited English proficiency for Hispanics, and in the last  two columns we show those same effects for Asians. Separate analyses  were done only for Hispanics and Asians because, as table 6 shows, the  percentage of children of other races whose parents have limited English  proficiency was very small. For the adjusted models, we also show the  effects of the other factors that we controlled for, such as income and  education, on the four outcomes. In the case of variables that have  multiple categories (such as race or ethnicity, income or poverty status,  education, and number of persons in the household over 18 years of age),  the odds ratios indicate how much more or less likely the categories of  families indicated are to have each outcome than the reference (or  omitted) category. The reference category for race or ethnicity is white,  the reference category for poverty status is less than 100 percent of the  federal poverty level, the reference category for education is less than high  school graduate, and the reference category for the number of persons in  the household over 18 is one.
Likelihood of receiving any nonparental care. Table 12 shows that  before adjusting for other factors, the effect of parents’ limited English  proficiency on the likelihood of receiving any type of nonparental  childcare was negative and significant for all groups considered together,  and for Hispanics and Asians considered separately (odds ratios of 0.28,  0.38, and 0.40, respectively). After controlling for these other factors, the  differences between children of parents with limited English proficiency  and other parents in terms of their receipt of any type of child care were  smaller for all groups considered together and for Hispanics (odds ratios  of 0.77 and 0.75, respectively), but not statistically significant among  Asians (odds ratio of 0.85). While almost all of the control variables attain  statistical significance in the model that included all racial and ethnic  groups, the statistical significance of individual control variables in the  models including only Asian or Hispanic children varies.
Likelihood of receiving financial assistance for child care. Table 13  shows that before adjusting for other characteristics, the odds ratios  estimating the effect of parents’ limited English proficiency on the  likelihood of receiving financial assistance for child care were 0.60, 0.46,  and 1.95 for all groups together, Hispanics, and Asians, although the result  for Asians was not statistically significant. While other factors were  significantly related to the likelihood of receiving financial assistance for  child care, controlling for their effects did not markedly diminish the  estimated difference between children of parents with limited English  proficiency and other children overall, or for Hispanics or Asians. After  other factors are taken into account, children of parents with limited  English proficiency were about half as likely as others to receive financial  assistance overall and among Hispanics (odds ratios of 0.41 and 0.44,  respectively), but among Asians the difference was not statistically  significant (odds ratio = 1.85).
Likelihood of receiving center-based care. Table 14 shows that before  adjusting for other factors, the effect of parents’ limited English  proficiency on the likelihood of receiving center-based child care among  those who received any type of child care was significant when all  racial/ethnic groups were considered together (odds ratio = 0.44), and  significant for Hispanics (odds ratio = 0.73) but not for Asians (odds ratio  = 0.92). None of the differences between children of parents with limited  English proficiency and other children were statistically significant,  however, after we controlled for other factors.
Likelihood of participating in Head Start. Table 15 shows that before  adjusting for other factors, children of parents with limited English  proficiency had higher odds of participating in Head Start when all  ethnic/racial groups were considered together (odds ratio = 1.39). The  same was true when Asians were considered separately (odds ratio =  3.81), but no significant effect of parents’ limited English proficiency was  found for Hispanics (odds ratio = 0.98). After controlling for other  characteristics, children of parents with limited English proficiency had  significantly lower odds of participating in Head Start when all  racial/ethnic groups were considered together (odds ratio = 0.67), and  when Hispanics were considered separately (odds ratio = 0.69), but  significantly higher odds among Asians (odds ratio = 1.90).
section_title: Appendix III: Comments from the U.S. Department of Health and Human Services
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: Betty Ward-Zukerman (Assistant Director) and Natalya Barden (Analyst- in-Charge) managed all aspects of the assignment. Laurie Latuda, Janet  Mascia, Jonathan McMurray, and Ethan Wozniak made key contributions  to multiple aspects of the assignment. Alison Martin, Grant Mallie, Amanda  Miller, Anna Maria Ortiz, James Rebbe, and Douglas Sloane provided key  technical assistance.