Simon Workman: You have friends who have kids in other programs and home-based programs, aren't accredited, but they love them and it's really great. And it's like, but how do you know that? So, until you're in a program, you really don't know it.

Jamee Herbert: Every family wants the best childcare possible for their child, a place where their children are safe, teachers are skilled, and the program is supporting the unique needs of their child. But right now, many families can't even find available care, let alone care that they can afford. They're not able to choose the best-quality program for their child. They just need something. How do we fix the disconnect between enrolling a kid in a program that's the best fit for them and just finding care that's available when families need it?

This is Child Care Matters: Built to Break, the podcast that asks why America's childcare system is built to break.

Today, we'll look at the issue of quality in childcare from all angles, what it means for parents, for providers, and for the policymakers hoping to extend quality childcare to as many families as possible. But how do we know what quality actually is? Who decides what it looks like? And most importantly, how do we measure it? I'm Jamee Herbert, CEO of BridgeCare, an organization that helps make navigating the minefield of early care and education easier.

I've spent years trying to understand why our childcare system feels impossible to work through. Every episode, we'll be looking at a different part of the equation, from the economics to the workforce, to the policy barrier shaping what care looks like on the ground. By the end of the season, you'll have a clearer picture of why America's childcare system has been set up to fail, and more importantly, what we can do to fix it.

This week, we asked the question, "How do we define quality childcare?"

Simon Workman: We were very aware of what the childcare market was like. It was definitely stressful because you don't find out until a month before that there's a spot available and it's like, "Well, I have to go back to work in April. Maybe we'll have a slot, maybe we won't. And how are we going to make it work?"

Jamee Herbert: This is Simon Workman. He's the principal at Prenatal to Five Fiscal Strategies, and you've met him on previous episodes, sharing his expertise in early childhood education. Like many in our field, he's also a parent who needed to find quality childcare for his family. Even though Simon is an expert, it's still hard for him to put his finger on exactly what quality childcare looks like.

Simon Workman: The quality conversation is so tough because we eventually had our child in an NAEYC-accredited program and you feel like, "Okay, there's something there. That's an accreditation that's there." But then you have friends who have kids in other programs and home-based programs, aren't accredited, but they love them and it's really great, but how do you know that? So, until you're in a program, you really don't know it. And even then, the program might give you updates, but it's still a matter of you're not seeing them every day, you don't know what the interactions are. So, that challenge of, you really see the need for parents to have some way to measure the quality of a program, but how do you find a measurement that actually fits everyone's definition of quality is almost impossible.

Sonja Castaneda-Cudney: Looking at websites, I felt like I couldn't find all of the information that I was looking for.

Jamee Herbert: Immediately, there's a first quality question that families face, "Is this childcare right for me?" As Simon says, until families experience it's difficult to even put your finger on what right is. Sonja Castaneda-Cudney, a parent who struggled to find the right childcare for her family echoes Simon's sentiments.

Sonja Castaneda-Cudney: Or I felt like it was presented in a way that seemed really wonderful on the surface, but I couldn't check it. How was I going to check? How do I know what certifications we have? What are other parents' experiences? I like to know that. And I feel like a lot of that didn't feel as accessible as I wish it would have been. And when we would go and visit these spaces, of course, things were great. They're perfect when you get there, but I wish we could have visited when things were in session.

We visited one of the daycares during the summer, so it was just our family and one of the directors and the teacher popped in for a minute, and we liked it. At the same time, I would have liked to see how things functioned on a real day with the students in place and everything else. Trying to find real information that answered the questions that I had was really challenging and I was surprised at how hard it was to get that information.

Jamee Herbert: It's not even just the challenge of knowing what quality should look like. It's a question of not being able to assess and measure it. Simon points out another layer here, making sure that people delivering the care are supported and enabled. Teachers may have the training for quality care, but if the program follows licensing ratios instead of quality-focused ratios, teachers may not be able to fully use their skills.

Simon Workman: The interactions between the teacher and the child to an outsider might look like you're just babbling to them while you're changing their diaper, but to a professional who understands the brain science sees exactly what that teacher is doing when they're changing the diaper of that child and they're making eye contact and they're making noises to them, and they're doing serve and return, all of these things that is building the brain architecture. That is something that if you have 12 infants in a classroom, you can't do that, you don't have the time to do that. So, that idea that you need to have the low-classroom ratios, low-group sizes, yet you also need to pay teachers so that they're not dealing with their own inability to feed their families and all the stress that comes with that.

Jamee Herbert: Quality in childcare isn't just defined by the quality of the caregiving, the facilities and the program. It's often tied to the safety of the physical space itself. Assessing that is another challenge that parents and providers face. To explain, here's Sarah Rittling, the executive director of the First Five Years Fund, an organization focused on advocating for bipartisan federal ECE policy.

Sarah Rittling: At the core, quality is health and safety, and we have to acknowledge that first and foremost. And then, from there, build out what we want. All of those things that a parent, or a grandparent, or a friend might go out and purchase for their own home in order to provide a safe space for their children, or their friend's children, or their family member to come to be even visiting in that house or to be living in that house. Now, magnify that by a lot of children in a setting. And then, also on top of that, are you going outside? Is the playground safe? Are the fences the right height?

Jamee Herbert: Sarah's referring to the non-negotiable part of quality childcare here, it has to be safe. But once that floor of basic health and safety is laid down, is that enough? How do we hold providers accountable? Wendy Doyle is the president and CEO of United WE, an organization that works to break down the barriers of women's economic growth and leadership. She explains how that accountability looks in practice.

Wendy Doyle: In Oklahoma, there's a five-star rating system and that means something different in every state.

Jamee Herbert: It's important to set standards for providers, but Wendy claims chasing this rating system can also have unintended consequences.

Wendy Doyle: So, what they are setting up from a quality perspective, but at every level of the star achievement, there's paperwork, there's cost, there's requirements. Some providers get to a point where they're like, "This is taking away from the actual care of the children to be able to excel to be a five-star rated," which really dictates how much subsidy that they are eligible to receive. So, of course you want the five star to be able to get the most money per child on the subsidy reimbursement, but the hoops and the expectation and the paperwork, some providers are, "I just am not equipped to be able to maintain that. It's great, it's wonderful, it's something to aspire to, but what I want to do with where I am, with my business, I want to just focus on doing good care for the children."

Jamee Herbert: What Wendy's talking about is how many states tie subsidy reimbursement rates to quality standards, especially the higher the quality of care, the higher rate the state pays the provider. But as Wendy pointed out, it's not as simple as that. We also have to look at the quality standards that states define and how they may differ between center-based and home-based care. On this topic, Erica Phillips is the executive director of the National Association for Family Childcare, a national nonprofit supporting early childhood educators.

Erica Phillips: I mean, there's just so much variety. What I will say is if you've seen one family childcare program, you've seen one family childcare program. They all approach things so differently from children coming in to lunch and how that's served to nap time. I mean, it really looks different. There are some people who have outdoor programs and they spend all day outdoor in their family childcare program. There's others who have incorporated Montessori basics into their family childcare program. There's bilingual family childcare programs who are communicating with children in different languages. It can look very different and it's customized to the children. They set their curriculum and what their schedule looks like based on the children and the families.

Jamee Herbert: What's becoming clear is how many layers there are to the question of quality. First, families have to decide if the care is right for them and if they can get the right information on what they need. Then, we need to talk about the skills of the people doing the caregiving. Is there specific training and education we expect from them and are they compensated to justify that investment in their own education? Underneath all of this is the non-negotiable. Is the facility safe? And after all of that, then we can look at how states set ratings and standards when there is no standard childcare setting.

That's a lot of variables with no one way of measuring all of them together. That's why I talked with Keller Anne Ruble, a solutions architect here at BridgeCare, an early childhood and public policy expert with more than a decade of experience helping governments and organizations strengthen their early childhood systems.

Okay. Keller Anne, can you talk to me about what does quality mean in childcare and is there a consensus on a definition of quality?

Keller Anne Ruble: Yeah. So, when we talk about quality in childcare environments, we really think about two things. We talk about structural quality. Structural quality are things related to quality environments that can be measured and that can be regulated. So, ratios, group sizes, teacher credentials. Then, we also think about process quality, the things that are related to a child's experience in the childcare environment, so what their interactions are like with their teachers and their classmates and their environments, how they are being cared for at each stage of development. Those are harder things to measure. They are not impossible to measure, but it's harder to do.

And so, a lot of our state-system definition of quality leans a little bit more heavier on the structural quality side rather than the process quality side, but the research is a little mixed. The things like teacher credentials and group sizes and ratio sizes, those are all related to quality environments, but those things themselves are not necessarily what makes quality interactions happen. So, you need to consider structural and process quality when it comes to the quality of a childcare environment. So, is there consensus in the field about what quality is? Some of the general factors that make for quality environment, but there is slight disagreement around what exactly makes high quality.

Jamee Herbert: Wendy mentioned Oklahoma's five-star system around quality standards. Can you speak a little bit more about the variety of QRIS, or quality rating improvement systems, and how they can work and differently in different places?

Keller Anne Ruble: Quality rating systems and the state differences are so interesting. A lot of people think about nationally like, "How do we measure quality? How can we understand the picture of quality at a national level?" You can't really do that very well because all states have different standards. There are, I think, 45 states with a quality rating and improvement system or a quality improvement system. The difference is just that the quality rating and improvement system has the rating associated. It's usually a one-to-five rating. What it means to be a one or a five in Alabama may be dramatically different than a one or a five in a different state.

On top of that, some of these programs are voluntary, so some providers are opting in and others aren't. And some are mandatory and when states have a mandatory QRIS, they often have different metrics to get from the first level to the second level than a voluntary program. A provider might be super high quality, but they might not see any incentive from the state to go through the paperwork, the costs, and the hoops that they have to jump through to move up in quality.

A lot of states will use incentives to encourage providers to move up in quality, but the biggest incentive that they're leaning on is higher reimbursement rates for childcare subsidies. But if you're a provider who doesn't take childcare subsidy, do you have much of an incentive to move up in quality, especially if parents like the care that you're providing and think it's quality care and trust you to provide a safe, warm, nurturing environment for their kid. There's this idea that quality rating and improvement systems will encourage parents to seek out the highest-rated programs.

And I think that would be the case in a perfect world where we weren't dealing with access and affordability issues, but we are. And so, parents have to balance what their priorities are when it comes to quality. And frankly, parents are not thinking about quality in the same way that the field is thinking about quality.

Jamee Herbert: I don't think anyone disagrees that quality is a good thing conceptually. There's just this difficulty in pinpointing what is quality, difference of opinion on quality, lack of standardization or challenges around standardization. Then, there's this other aspect Wendy mentions around the administrative burden, particularly of quality improvement systems and some of the state standardization. Can you talk more about what that looks like and why it can be burdensome on providers?

Keller Anne Ruble: So, as I said earlier, states have tried to incentivize providers to move up in quality and take on new quality improvement activities by offering them higher reimbursement rates for each level. But sometimes either the juice is not worth the squeeze, that the increase in reimbursement is not as meaningful to the provider as the cost it takes to move up from a four to a five. And the reimbursement increase might not be commensurate to the time, resources and energy that they've invested.

Providers are working on razor-thin margins as is, and they really have to make a lot of hard decisions about what is worth a further investment and what is not. And if maybe going up to a higher rating level might be increasing their teacher credentials, well, that is expensive to go back to school or to take more classes. And oftentimes, it is during the workday when they're providing care. So, you might have to have a teacher lose wages in order to go to school and get the increased credential, which arguably, is a good thing to get an increased credential, but they're so low paid as is to ask them to lose wages each day that they're in class is really unfair.

Jamee Herbert: There's all these challenges and it's good to have something and also there's limitations maybe to standardization. Do we think that like just good enough is worth doing still or do we still keep trying to push forward with it?

Keller Anne Ruble: I struggle with the concept of good enough when it comes to our nation's kids. I mean, when we're thinking about the function of childcare, it's helping build young children's brains and supporting their growth and development. How we care for children is laying the foundation for how they will approach relationships, self-esteem, work, and so much more as they grow up and at each stage and phase of their lives. And so, what's good enough frankly feels a little reductive because caring for kids and nurturing their growth and development is very hard work. And I want us to have the best for our kids. I don't want what's good enough or what is like the minimally defined measure of this is a safe place for them to be where their parents are working.

Jamee Herbert: Over the course of the season, we heard about health and safety and licensing from Sarah. We heard about teacher-child interactions from Simon and difficulty getting to information. And we heard about quality rating systems from Wendy. What do you think we're over-indexing and under-indexing on right now in this system, and particularly as it relates to quality?

Keller Anne Ruble: I think some things are easier to measure than others, and the things that are easier to measure, whether that's because it's lower human costs, because you're not having someone come in and look and see these things... Teacher credentials is one. People can submit all of the credentials of their staff easy-peasy. That's not something that requires a ton of effort to go visit the facility. I think we're over-indexing on stuff that's easier to measure, but has a direct causal relationship to increase quality and increased child outcomes.

We are under-indexing on interactions between children and their caregivers because to do that requires us coaches or quality improvement specialists, monitoring specialists to go in and observe the classroom and see what's happening during all points of the day. There are states who have done that. Louisiana, their quality rating and improvement system has been really heavily rooted in interactions and the quality of interactions.

And they use an observational measurement tool called CLASS to assess the quality in their childcare centers and homes. There has been research that has shown that they have really moved the needle not just on overall quality ratings, but child outcomes in kindergarten, third grade, and that's the power of quality interactions. It can be done, but that requires a little bit heavier investment from states on the monitoring and evaluation and of side of things.

Jamee Herbert: To get to the more causal indicators around child outcomes typically requires more cost investment, more human time-intensive investment, and also, I would imagine just more difficult to standardize across how to measure those things as well. Harder to get consensus around as well.

Keller Anne Ruble: Exactly. And what environments? So, consensus around what it looks like in a home versus a center. When we focus too heavily on those easy-to-measure things, then it becomes this reinforcing cycle of... Similar to in K-12 education with standardized tests. It's easy to measure English and math, and a lot of school funding and teacher pay and things are dependent on how students perform on these standardized tests. So, sometimes instead of teaching the material, you're teaching to the test. And it's not about the learning, it's then about, are you a good test-taker?

Jamee Herbert: What you measure matters.

Keller Anne Ruble: Yes.

Jamee Herbert: And so, when we're measuring on these things that are easy to measure, which makes sense why they do, but then we over-index and overemphasize those things and, as a result, under-emphasize and under-invest in the things that are important but harder to measure?

Keller Anne Ruble: Exactly. Exactly.

Jamee Herbert: Some of my biggest takeaways from the conversation today. First is just how little is even known by the public and families about this quality system that we have created in our society in the US, that government has funded and many organizations put a lot of resources into supporting. I think it's really important that there's even awareness about this and education about these resources and supports for families to understand and navigate quality. After that, it's really important to understand the challenge of actually defining quality and also enforcing any measures of quality due to the challenges of this broken system around access, affordability, and the difficulty in measuring the things that truly matter in quality. And so, while all of these efforts are well-intended and overall are better than having no systems in place, we're still on the road to actually implementing, measuring, and supporting what a true quality system can look like in almost all states.

Across this series, we're showing you every piece of the puzzle of the system that has been built to break. In the next episode, we ask, "What's the true cost of insufficient childcare in America?" We can only fix the system if we first understand why and where it's broken. So, subscribe and share this podcast with others who are navigating the system too. And go to getbridgecare.com if you want to learn about what can be done to help families access high-quality affordable childcare. The link is in the show description.