Quality in Child Care and How to Measure it

1
Quality in Child Care and How to Measure it

• The Environment Rating Scales
• Training for Child Care Health Consultants
• Holly Clendenin, RN
• Child Care Health Consultation

2
Training Objectives

• Identify 3 reasons why we want to measure quality
  in child care
• Identify 4 Environment Rating Scales and assess
  what scale is appropriate to use and when
• Describe the role of the CCHC in using the
  Environment Rating Scales

3
Training Objectives

• Describe how to administer the ITERS Scales
• Be familiar with scoring, alternate scoring, and
  the score sheet and profile of the ITERS
• Be familiar with terms used throughout the
  ITERS-R and ECERS-R

4
Training Objectives

• Be familiar with the subscale Personal Care
  Routine and the indicators and items in the
  subscale
• Video training and practice scoring the ITERS-R
  and ECERS-R
• Practice with a center in your area scoring their
  personal care routine and giving feedback on your
  observations

5
Ways to Measure the Quality of Childhood Programs

• There are two major approaches to measuring the
  quality of early childhood programs. One approach
  uses structural indicators of the program such as
  staff-child ratio, group size, teachers
  educational levels, and square footage per child.
  Structural indicators form the basis for
  out-of-home child care regulation and they are
  important to insure that quality care has been
  documented.

6
Ways to Measure the Quality of Childhood Programs

• The other approach measures quality through
  observation of ongoing processes, such as
  staff-child, child-child, staff-staff, and
  staff-parent interactions, and the interactions
  staff and children have with the early childhood
  setting and materials. This latter approach is
  called process quality assessment.

7
The Environment Rating Scales

• The Harms, Clifford and Cryer Environment Rating
  Scales (ECERS-R, ITERS-R, FCCERS-R and SACERS)
  are designed to assess process quality in an
  early childhood or school-age care setting.
  Assessment of process quality has been found to
  be more predictive of child development outcomes
  than structural indicators (Whitebook, Howes and
  Phillips, 1995).

8
Harms, Clifford and Cryer Environment Rating
Scales
9
Four Environment Rating Scales

• These four scales share the same format and
  scoring system but vary considerably in
  requirements, because each scale assesses a
  different age group and/or type of child
  development setting.

10
Four Environment Rating Scales

• The guiding principle of all the Environment
  Rating Scales is to focus on what we know to be
  good for children.

11
SACERS

• SACERS (1996) The School-Age Care Environment
  Rating Scale Designed to assess before- and
  after-school group care programs for school-age
  children, ages 5 to 12 years. The total scale
  consists of 49 items, including 6 supplementary
  items for programs enrolling children with
  disabilities.

12
FCCERS-R

• FCCERS-R (2007) The Family Child Care Rating
  Scale-Revised Designed to assess family child
  care programs conducted in a providers home with
  infants and children from birth through
  school-age. Total scale consists of 37 items. The
  FCCERS-R is a thorough revision of the original
  FDCRS.

13
ECERS-R

• ECERS-R (2005) The Early Childhood Environment
  Rating Scale-Revised Designed to assess group
  programs for preschool through kindergarten-aged
  children, from ages 2 ½ through 5 years. Total
  scale consists of 7 subscales and 43 items. The
  ECERS-R is a thorough revision of the original
  ECERS (1980). The 2005 edition is an updated
  version of the 1998 ECERS-R. This scale is also
  available in Spanish.
• The CCHC will most likely use this scale to
  access the Personal Care Routine This is a
  challenging area for most child care centers and
  the area they will often have their lowest
  scores. STARS will often request your assistance
  with improvement in this area.

14
All About ECERS-R
15
ITERS-R

• ITERS-R (2006) The Infant/Toddler Environment
  Rating Scale-Revised Designed to assess group
  programs for infants and toddlers ages birth to
  2½ years. Total scale consists of 7 subscales and
  39 items. The ITERS-R is a thorough revision of
  the original ITERS (1990). The scale is also
  available in Spanish.
• The CCHC will most likely use this scale to
  access the Personal Care Routine This is a
  challenging area for most child care centers and
  the area they will often have their lowest
  scores. STARS will often request your assistance
  with improvement in this area.

16
All About ITERS-R
17
Characteristics of Scales

• Each scale has items to evaluate
• Physical environment
• Basic care
• Curriculum
• Caregiver/child interaction
• Schedule/program structure
• Provisions for parent/staff

18
Characteristics of Scales

• The scales are suitable for use in evaluating
  inclusive and culturally diverse child care
  programs. Inclusive programs enroll children
  with special needs as well as children who are
  typically developing.

19
Characteristics of Scales

• The scales also have proven reliability and
  validly, which makes them suitable for research
  and program improvement.
• Reliability is the extent to which an
  experiment, test, or any measuring procedure
  yields the same result on repeated trials.
• Validity refers to the degree to which a study
  or tool accurately reflects or assesses the
  specific concept that the researcher is
  attempting to measure.

20
Basic Components Of Quality In Child Care

• Harms (1997) proposes three basic components
  of quality in child care. In order to provide
  quality child care, programs should strive to
  meet the individual and group needs of children
  in these three areas
• Physical needs Protection of childrens health
  and safety and prevention of abuse and neglect
• Social/Emotional needs Building relationships
  with children, parents/guardians, extended
  family, and community
• Cognitive needs Opportunities for stimulation
  and learning from experience

21
Why Do We Measure Quality?
22
We Measure Quality

• To use in Research
• For Program Improvement
• To Predict Success

23
Measure Quality for Research

• Because quality of child care is such a strong
  predictor of school and social success, the
  ECERS, ECERS-R, ITERS, and ITERS-R have been used
  in many prominent studies as a comprehensive
  measure of quality.

24
Measure Quality for Program Improvement

• The second use of the Environment Rating
  Scales is measuring quality with the intent of
  using the results for program improvement. The
  scales are used in a variety of ways including
  self-assessment by center staff, preparation for
  accreditation, and voluntary improvement efforts
  by licensing or other agencies in the US and
  around the world such as National Association for
  the Education of Young Children (NAEYC) and STARS.

25
Measure Quality to Predict Success

• Thirdly, using the ECERS, the Cost, Quality,
  and Child Outcomes Study found that the quality
  of child care was related to cognitive
  development and social skills through second
  grade (Peisner-Feinberg, et al., 1999).

26
The Role of the CCHC

• The Child Care Health Consultant (CCHC)
  plays a significant role in improving the health
  and safety and overall quality of child care
  programs. The CCHC will need to
• Develop competence in using a guided observation
  tool for rating quality in child care settings
• Develop good observational skills through
  practice in child care settings
• Apply collaborative consultation skills in making
  a plan of action to improve quality in child care
  settings

27
The Role of the CCHC

• By observing in a classroom for several hours
  using the appropriate environment rating scale,
  the CCHC can become well acquainted with the
  day-to-day functioning of the child care program.
  Such realistic knowledge of the program enables
  the CCHC to provide practical, relevant support
  and encouragement to the child care staff for the
  improvement of quality. Knowledge of the
  realities of child care helps the CCHC to adapt
  health-related materials and approaches for
  implementation in child
• care settings.

28
Observation in the Classroom

• Observation is an essential tool for
  consultation. It is the key to understanding the
  current child care situation so practical
  recommendations can be made for improvements in
  child care quality. A good observer minimizes the
  effect of his/her presence on the classroom. See
  the Classroom Observation Guidelines in
  Appendix A.

29
How the CCHC Can Use the Scales

• The CCHC should use the scales to identify the
  child care centers strengths and needs.
• The CCHC should use the scales to collaborate
  with the staff to improve quality in the center.
  The CCHC may also collaborate with STARS in
  working towards a higher stars rating.

30
How Not to Use the Scales

• The CCHC should not use the scales for any other
  purpose other than consultation.
• The CCHC should not share the rating scales with
  anyone external to the child care facility,
  including any organization, agency, regulatory
  body including the state child care regulatory
  agency.

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ITERS-R
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Instructions for using the ITERS-R

• Turn to page 5-9 of ITERS-R
• Administration of the Scale
• Scoring System and Alternate Scoring
• The Score Sheet and Profile
• Explanation of Terms Throughout the Scale
• Overview of Subscales and Items

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ITERS-Scoring and Score Sheet Profile

• Scoring system, Page 6
• Alternate Scoring, page 6
• The Score Sheet and the Profile, page 6
• Sample of a filled in Score sheet and Profile,
  page 62

34
ITERS- Understanding Scoring

• Because of many variables such as cultural
  preference, or beliefs of adults involved, the
  curriculum approach used, the physical conditions
  of the building, finances, or staffing issues, it
  is unlikely that programs will score uniformly
  high on all the requirements of the scale.
  Instead, programs will have both strengths and
  weaknesses in their scores.

35
ITERS- Understanding Scoring

• Evaluating the scores with the center gives
  program staff the opportunity to consider where
  change is needed, and to determine how to create
  desired improvement. The important thing to
  remember is that the individual requirements of
  the scales is far less important than the average
  total score for any classroom. It is the average
  total score that is related to positive child
  development.

36
Explanation of Terms Used Throughout the Scale

• Example of terms used, page 7-8
• Accessible
• Appropriate
• Hand washing
• Infants and Toddlers
• Much of the day
• Some and many
• Usually
• Weather permitting

37
ITERS-R Video Guide and Training Workbook

• Part I ITERS-R Workbook
• Play Part I Introduction on video
• Turn to p.1, Video Guide and Workbook and review
  subscales and items
• Turn to p.2, Sample Item Display for children.
  Note progression from 1 to 7
• Turn to p.3, Scoring Instructions

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ITERS-R Video Guide and Training Workbook

• 5. Turn to page 5-6, Scrambled Item Activities
  and work in pairs deciding the proper order of
  1,3,5,7 progression. Explain rationale.
• 6. Page 6-8, Sample Situations for Scoring
  Practice. Work in pairs to score items. Why did
  they score what they did? What changes would they
  make for improvement?

39
ITERS-R Guide and Training Workbook

• Part II ITERS-R Workbook
• Play Part II Introduction on video
• Read p.9, Items for Scoring the Video Observation
• Score Items on page 10-16

40
ITERS- R Personal Care Routine

• Page 18-29
• Greeting and Departing
• Meals and Snacks
• Nap
• Diapering/ Toileting
• Health Practices
• Safety Practices

41
Observing the Right Thing at the Right Time

• When completing the scales some things that need
  to be observed happen only at certain times of
  the day, while others can be observed at almost
  any time. For example, Meals and snacks must be
  observed as soon as preparation for the feeding
  process begins to see proper sanitation of tables
  and proper hand washing of staff and children.

42
ITERS- R Personal Care Routine-Greeting/Departing

• Warm greetings/departures with children and
  parents are necessary to meet childrens
  social/emotional needs. Greeting children in a
  positive way helps them feel welcome in the
  classroom and sets the tone for the whole day.
  Infant and toddlers experience heightened
  separation and stranger anxieties and a warm
  greeting will help them feel more confident about
  leaving their parents. When parents and staff
  calmly exchange child related information,
  children get the message that they will be well
  cared for and that they are valued.

43
ITERS- R Personal Care Routine-Greeting/Departing

• Warm greetings to children and parents are
  necessary to provide an opportunity for
  communication and share required information.
  This is important especially with
  infants/toddlers because they are vulnerable to
  problems in a wide range of health, safety and
  developmental issues.

44
ITERS- R Personal Care Routine-Greeting/Departing

• Warm greetings/departures with children and
  parents are necessary to ensure childrens
  safety. From the safety point of view, greeting
  and departing helps, staff and parents to
  formally transfer responsibility for the child.
  Through greeting, staff register in their minds
  each child who is present. At departure, staff
  know who picked up the child and when they left
  their care.

45
ITERS- R Personal Care Routine-Meals and Snacks

• The feeding of infants and toddlers requires a
  combination of specialized information about each
  childs nutritional and developmental needs along
  with emphasis on the essential sanitary
  procedures that protect childrens health in
  group care.

46
ITERS- R Personal Care Routine-Meals and Snacks

• A meal/snack schedule that meets individual
  needs is one in which each child is fed according
  to the standards of the US Department of
  Agriculture (USDA) Child and Adult Care Feeding
  Program (CACFP). These standards are to be used
  whether or not the program is participating in
  the USDA Child and Adult Care Feeding Program.
  See Child and Infant Care Eating Patterns
  Handout.

47
ITERS- R Personal Care Routine-Meals and Snacks

• The Basic Sanitary Procedures considered when
  scoring this item they are
• Hand washing of adults and childrens hands
• Clean and sanitized eating equipment and surfaces
• Uncontaminated Food

48
ITERS- R Personal Care Routine-Nap

• This item considers aspects of nap that go
  beyond schedule and includes evaluating the
  measures required for the protection of the
  childrens health, safety and comfort while
  sleeping.
• Children should sleep on a clean nap surface
  not directly on the floor, alone and not a shared
  place, at least 36 from another cot or mat, with
  clean individual bedding, with bedding stored
  separately, and sleep surface easy to wash.

49
ITERS- R Personal Care Routine-Nap

• This item considers aspects of nap that go
  beyond schedule and includes the type of adult
  supervision. A staff member should be actively
  supervising in the room and another immediately
  available for emergencies. Regular ratios should
  be maintained for infants since they nap all day
  at varies times. Supervision should be pleasant,
  responsive, and warm.

50
ITERS- R Personal Care Routine-Nap

• This item considers aspects of nap that go
  beyond schedule and includes the extent to which
  nap is personalized. Nap routine is carried out
  with each childs preferences in mind, ensuring
  the comfort and security of every child. Examples
  might include, pictures of familiar people placed
  where child can see them, infants placed the same
  direction each time in crib, childs cot placed
  near same friend, same individual routine used to
  get infant settled such as rocking each time.
  Make provisions for early risers or
  non- nappers.

Gracie
51
ITERS- R Personal Care Routine-Diapering/Toileting

• This item is concerned with maintaining
  sanitary conditions during diapering/toileting to
  minimize the spread of germs. In addition to
  basic health concerns, this item examines the
  social-emotional and learning aspects of the
  diapering/toileting routine.

52
ITERS- R Personal Care Routine-Diapering/Toileting

• Sanitary Conditions look closely at cleaning and
  sanitizing to minimize the spread of germs and
  include hand washing and sanitizing diapering and
  toileting surfaces with a two step process.
• Maintaining sanitary conditions requires a
  separate sink used only for hand washing after
  diapering and toileting. Toilets must be flushed.
  If potty chairs are used they must be sanitized
  after each use. Area for diapering and toileting
  must be kept clean. Trash must be disposed of
  properly in a hands- free trash can.

53
ITERS- R Personal Care Routine-Diapering/Toileting

• Also this items looks at sanitary conditions
  to avoid contamination during diapering and
  requires the following diapering and hand washing
  procedures. See All About ITERS-R, page 109-118.

54
ITERS- R Personal Care Routine-Diapering/Toileting

• This item also looks at supervision during
  diapering/ toileting, meeting the diapering/
  toileting needs in an appropriate manner,
  provisions for equipment and supplies, Self help
  measures for children and staff and child
  interactions. See All About ITERS-R, page 118-124.

TAL
55
ITERS- R Personal Care Routine-Health Practices

• This item considers health related issues
  other than those required for, toileting/diapering
  meals and snacks, and nap. Instead, all other
  important health practices used with the group of
  children to evaluate the quality of the general
  health practices must be examined. In scoring
  this item, listen and watch for examples of how
  staff act to cut down on the spread of germs.

56
ITERS- R Personal Care Routine-Health Practices

• This item looks at keeping spaces, materials,
  and equipment clean.
• Examples surfaces that come in contact with
  bodily fluids, toys that have been soiled or
  mouthed, pacifiers, tooth brushes, floor
  surfaces, dress up clothes, trash cans, and areas
  outside contaminated by animals.

57
ITERS- R Personal Care Routine-Health Practices

• This item looks at ensuring proper hand
  washing, (except times during diapering/toileting
  and meals/snacks)
• Examples Upon arrival in the classroom for
  children, staff and (parents if they stay) When
  returning from outdoor play, after staff have
  been working in another classroom, after messy or
  sand or water play, after sneezing or coughing
  and after touching pets or contaminated object.
  See chart 1, All About ITERS-R, page 128.

58
ITERS- R Personal Care Routine-Health Practices

• This item looks at the health concerns of a
  childs clothes that may be wet or soiled and
  requires that an extra set of clothes for each
  child be provided.
• It looks at how Rx and non Rx medications are
  handled.
• It looks to see that children are dressed
  properly for the weather.
• It also looks to see if staff are
• good models of health.

59
ITERS- R Personal Care Routine-Health Practices

• This item looks to see if children are
  encouraged to do as much as they can to carry out
  health practices independently and if educational
  materials are used. This could include, hand
  washing posters by the
• sink, teaching them to sing a song while hand
  washing, books talking about health practices and
  familiar personal care routines such as
  brushing their teeth.

60
ITERS- R Personal Care Routine-Safety Practices

• Safety practices consist of a combination of
  minimizing hazards in the spaces used by children
  and diligent supervision by adults who care for
  them. This item looks at all hazards found in
  indoor and outdoor spaces used by or accessible
  to children. See examples in, All About
• ITERS-R, page140-143. See handout
• Playground Information to Use
• with Environment Rating Scales.

61
ITERS- R Personal Care Routine-Safety Practices

• This item also looks at supervision
• (watching and protecting children from danger)
  provided by staff both indoors and outdoors. You
  are looking to see if there is enough staff to
  watch all areas used and whether adults are
  supervising the most hazardous areas and
  activities adequately.

62
ITERS- R Personal Care Routine-Safety Practices

• This item looks at the essentials needed to
  handle emergencies and deal with accidents, fire,
  or other dangers that require immediate action.
  Examples are telephone, emergency numbers,
  substitutes for staff, first aid kit
  transportation, written emergency policies, and
  staff trained in emergency procedures.

63
ITERS- R Personal Care Routine-Safety Practices

• This item also looks to see if staff takes
  action to anticipate and to prevent safety
  problems. Examples moving active play away from
  quiet play, placing problem objects out of reach,
  periodically removing clutter on floor, removing
  broken toys, identifying choking hazards, tying
  childrens shoes, and ensuring gates and doors
  are closed.

64
ITERS- R Personal Care Routine-Safety Practices

• This item also looks at helping children to
  follow safety rules and if rules used with
  children are reasonable. List of reasonable and
  unreasonable rules in All About ITERS-R,
  page150-151.
• Reasonable rules such as Be gentle use a soft
  touch. Pulling hair can hurt.
• Stay with me. Im afraid I will lose you.
• No hitting. Hitting hurts. You can ask with
  words.
• We dont take toys from our friends Lets
  find another toy.
• Dont touch, the slide is too hot to play on
  today
• Unreasonable rules such as Share the toy.
• Stay in your place and dont touch anybody.

65
Action Items for CCHC

• Identify the child care centers strengths and
  needs and communicate to child care director what
  they are, using both written communication and a
  face to face meeting. See example of letter.
• Collaborate with the child care staff/and or
  STARS to improve quality in the center.
• Provide the Child Care Staff with assistance and
  training in the CCHCs areas of competence.
• Identify additional training resources for needs
  outside the CCHCs area of competence.
• Follow up to see if plans for improvement are
  implemented.

66
Practice ITERS-R

• See Instructions and Sample Observation
  letter. Choose a center in your area and arrange
  an observation time to look at and score their
  Personal Care Routine. You should arrange the
  time for your visit to see as much as possible of
  their Personal Care Routine. Allow at least 2
  hours for this. You should allow enough time and
  make arrangement to see their outside play area
  to evaluate safety hazards.

67
Practice ITERS-R

• After your observation write a letter to the
  director or teacher giving feedback on your
  observations and suggestions for improvement.
• Arrange a time to talk to director or teacher in
  person to go over your findings.

68
ECERS-R Video Guide and Training Workbook

• Part I ECERS-R Workbook
• Part II ECERS-R Workbook

69
Sources

• All About the ITERS-R by Thelma Harms, Debbie
  Cryer and Cathy Riley
• National Training Institute (NTI) Training Module
  Quality in Child Care and How to Measure it The
  Environment Rating Scales, version 4
• Infant/ Toddler Environment Rating Scale, Revised
  Edition, by Thelma Harms, Debbie Cryer and
  Richard Clifford
• Early Childhood Environment Rating Scale ,
  Revised Edition, by Thelma Harms, Debbie Cryer
  and Richard Clifford
• NTI Presentation Quality in Child Care and How
  to Measure it The Environment Rating Scales
• Video Observations for the ITERS-R and ECERS-R,
  by Thelma Harms and Debby Cryer
• Thanks to my NTI mentor, Sandra Ciancilio, RN and
  my CCHC mentor, Catherine Lowe, RN