Quality in Child Care and How to Measure it

The Environment Rating ScalesTraining for Child Care Health

Consultants

Holly Clendenin, RNChild Care Health Consultation

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

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

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

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.

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.

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).

Harms, Clifford and Cryer Environment Rating Scales

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.

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.

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.

FCCERS-R FCCERS-R (2007) The Family Child

Care Rating Scale-Revised: Designed to assess family child care programs conducted in a provider’s 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.

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.

All About ECERS-R

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.

All About ITERS-R

Characteristics of Scales

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

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.

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.

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 children’s 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

Why Do We Measure Quality?

We Measure Quality

To use in Research

For Program Improvement

To Predict Success

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.

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.

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).

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

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.

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.

How the CCHC Can Use the Scales

The CCHC should use the scales to identify the child care center’s 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.

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.

ITERS-R

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

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

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.

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.

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

ITERS-R Video Guide and Training Workbook

Part I ITERS-R Workbook1. Play Part I Introduction on video2. Turn to p.1, Video Guide and

Workbook and review subscales and items

3. Turn to p.2, Sample Item Display for children. Note progression from 1 to 7

4. Turn to p.3, Scoring Instructions

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?

ITERS-R Guide and Training Workbook

Part II ITERS-R Workbook

1. Play Part II Introduction on video2. Read p.9, Items for Scoring the

Video Observation3. Score Items on page 10-16

ITERS- R Personal Care Routine Page 18-29 Greeting and Departing Meals and Snacks Nap Diapering/ Toileting Health Practices Safety Practices

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.

ITERS- R Personal Care Routine-Greeting/Departing

Warm greetings/departures with children and parents are necessary to meet children’s 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.

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.

ITERS- R Personal Care Routine-Greeting/Departing

Warm greetings/departures with children and parents are necessary to ensure children’s 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.

ITERS- R Personal Care Routine-Meals and Snacks

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

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.

ITERS- R Personal Care Routine-Meals and Snacks The Basic Sanitary

Procedures considered when scoring this item they are:

Hand washing of adults and children’s hands

Clean and sanitized eating equipment and surfaces

Uncontaminated Food

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 children’s 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.

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.

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 child’s 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, child’s 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

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.

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.

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.

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

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.

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.

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.

ITERS- R Personal Care Routine-Health Practices

This item looks at the health concerns of a child’s 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.

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.

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.

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.

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.

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 children’s shoes, and ensuring gates and doors are closed.

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. I’m afraid I will lose you.” “No hitting. Hitting hurts. You can ask with words.” “We don’t take toys from our friends Let’s find another toy.” “Don’t touch, the slide is too hot to play on today” Unreasonable rules such as; “Share the toy.” “Stay in your place and don’t touch anybody.”

Action Items for CCHC Identify the child care center’s 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 CCHC’s areas of competence.

Identify additional training resources for needs outside the CCHC’s area of competence.

Follow up to see if plans for improvement are implemented.

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.

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.

ECERS-R Video Guide and Training Workbook

Part I ECERS-R Workbook

Part II ECERS-R Workbook

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