SPECIALIZED CHILD CARE

INTRODUCTION

There are currently few providers for those in need of specialized child care: care during nonstandard hours, sick-child care, and special-needs care. The employment opportunities of many welfare recipients are jeopardized not only by this shortage, but also by two emerging forces: the rise in welfare work participation rates from 25 to 35 to 50 percent, and the relative increase in job opportunities during nonstandard hours. It is projected that even less of the need for child care can be met as more welfare recipients enter the workforce and that there will be an even greater demand than at present for specialized care, particularly during nonstandard hours. Unless welfare agencies and others develop approaches that ensure the availability of child care, particularly specialized child care, welfare recipients cannot be expected to meet work participation requirements.

This section provides information on and addresses the following questions related to the need for specialized child care among welfare recipients:

NEED FOR SERVICES:

• How is specialized child care defined?
• What percentage of the welfare population faces this as a barrier to employment?
• What relationship does the need for specialized child care have to welfare dependency and employment?

Definition

The scarcity of child care is rapidly gaining national attention, though it has long been recognized as a significant obstacle for people trying to enter the labor force. Put quite simply, without someone to watch the child, a parent cannot be expected to work. The barrier that child care poses to employment is proportionate to the size of the gap between supply and demand. This gap comprises several dimensions, including affordability, quality, and access.

A comprehensive review of these issues, however, goes well beyond the scope of this document. We focus instead on the gap between the need for and supply of three particular types of care that are seldom addressed but that pose serious barriers to employment for those making the transition from welfare to work: (1) nonstandard-hours care, (2) sick-child care, and (3) special-needs care.

• Nonstandard-hours care is care needed during early mornings, evenings, nights, and weekends, as well as shifts longer than eight hours (GAO 1995).
• Sick-child care, or care for "mildly ill children," is care for children who are too sick to attend school or child care (National Association for Sick Child Daycare 1997).
• Special-needs care is care for children with physical, emotional, or mental disabilities (GAO 1995). Disabilities range from cerebral palsy and autism to attention deficit and speech disorders and hearing and vision problems.

ESTIMATION OF NEED:

• Table 1: Need estimates
• Table 2: Supply estimates

Percentage of Welfare Population Facing This Issue

Table 1 in Appendix A provides estimates of the need for child care in each of the three specialized areas. Table 2 in Appendix A then provides estimates of what is known about the supply. Ranges are presented in the box above. In no case are these estimates based on a single study that has analyzed both issues simultaneously. The primary difficulty even in estimating the proportion of the welfare population needing specialized child care in order to work is that studies do not examine both need and supply together. So while anywhere from 10 to 72 percent need child care during nonstandard hours, it isn't clear if the 72 percent are located in an area with 12 percent of the supply (and the 10 percent located in areas with 41 percent of the supply), or vice versa. Lack of information about the supply of unregulated care further complicates the issue of estimating who faces a barrier to employment as a result of the need for specialized child care. Some people who live in areas and work under conditions that theoretically pose the greatest challenge to sustaining employment (for example, working nonstandard hours where there are very few care providers during these times) may have an extensive network of informal support to compensate.

The following factors contribute to the ranges in estimates above:

• Barrier Definition. On the supply side, the range of estimates is wide, depending upon the type of care provider. For sick-child care, centers are much less likely to provide care than are regulated or nonregulated family day care providers. The opposite is true for special-needs child care, however, for which centers are most likely to provide care.

• Study Sample. Some estimates are based on a sample that is unrelated to the supply of care--for example, the percentage of those who work nonstandard hours or have special-needs children. Other estimates, however, are based on a sample more closely related to the supply of care--for example, those who request specialized care or who have had a problem finding care. These estimates will vary, and it is certainly much less clear to what extent there is a barrier to employment for samples defined in a way that is unrelated to supply of care.
• Demographic Characteristics. Certain demographic characteristics also affect the estimation of the barrier to employment posed by the need for specialized child care. As is true for any child care, amount and source of income play a large role in determining the extent of a problem affording and obtaining acceptable specialized care. The age of the child also is a factor in the availability of child care. One study, though not based on specialized child care, found that the supply of care in Chicago for preschool children could meet 75 percent of demand, whereas the supply of infant care could meet only 16 percent of demand (GAO 1997).
• Employment Profile. The extent to which the need for specialized child care poses a barrier to employment is also a function of work characteristics: the number of hours worked, flexibility in hours worked, and benefits provided (such as paid sick leave). One study that has looked at the employment profiles of those who move from welfare to work estimates that the number of former welfare recipients whose jobs grant paid sick leave is less than 30 percent (Rangarajan 1996). As the number of hours worked increases, the percentage of those who rely on formal care (center-based care or nonrelative family care) also increases (Smith 1995). While formal care is more likely to cover children with special needs, it is least likely to cover sick children or be available during nontraditional hours.
• Geographic Location. Geographic location affects the gap between supply of and demand for care, specialized or otherwise. Poor areas often have a limited supply. For example, though the current supply of infant child care in Chicago can meet 16 percent of demand, as noted above, the current supply of infant care in poor areas in Chicago can meet only 11 percent of demand (GAO 1997). Welfare recipients in rural areas also frequently face both supply and accessibility difficulties, as a result of the greater constraints posed by inadequate transportation systems. Finally, there are differences in how states have earmarked and allocated funding for child care, which will contribute to differences in the local supply of care that is affordable and available to welfare recipients.

Relationship to Welfare Receipt and Employment Status

The following information pertains to general child care issues, rather than our three specialized areas. In all likelihood, however, the relationship to welfare receipt or employment status highlighted below is similar to or more extreme for those with specialized child care needs.

• More than 40 percent of all poor nonworking mothers with infants report child care problems as the primary reason for not being in the labor force (Kisker and Ross 1997).
• Researchers have found that high day care costs discourage women's entry into the labor force (Smith 1995).
• Sixty percent of participants in welfare-to-work programs in 38 states reported lack of child care as a barrier to work (GAO 1997).
• An evaluation of GAIN, the job-training program for welfare recipients in California, found that welfare mothers who were concerned about their children's safety and did not trust their providers were twice as likely to drop out of the program as were mothers satisfied with their child care arrangements (Gilbert et al. 1992).
• In a 1990 study, nearly one out of every six mothers employed outside the home reported losing some time from work in the previous month because of a problem with child care arrangements (New York City Department of Business Services 1991).

Welfare Agency Approaches

What can welfare agencies do to assist clients who face the need for specialized child care as a barrier to employment?

• What does the evidence suggest about the effectiveness of addressing this barrier?
• What do we know about program costs?
• What do we know about program implementation?

Client Identification

Identification of clients in need of specialized child care--nonstandard-hours, sick-child, and special-needs care--is usually far less complex than identification of clients with other barriers to employment. However, because resources are limited, it is often quite difficult for agencies to meet clients' needs. Generally, a designated caseworker will meet with each client to assess needs and develop a list of accessible and acceptable child care providers. Clients make the final decision as to which provider to use, but they usually have few options available to them. Transportation barriers may further reduce the number of options. Back-up care, for times when a child is sick, is rarely addressed. When clients' circumstances change (as they move from subsidized employment to unsubsidized employment, change jobs, or change the number of hours worked), caseworkers must repeat this process based on a new needs assessment.

Program Strategies

The barrier that lack of child care options poses for welfare recipients who work nonstandard hours, who have a sick child, or who have a child with special needs has received little direct attention. The larger issues of the general need for affordable, accessible, high-quality care have largely overshadowed this issue, though responses to this general need may ultimately benefit those in need of specialized child care as well. For example, the need for specialized child care will naturally be served by initiatives that include federal and state funding efforts, employer programs designed to meet employee child care needs, incentive programs for child care providers, and welfare agency efforts that earmark additional funds for child care and that develop expedited systems for assisting clients in finding this care.⁽¹⁾ What we review here are only those efforts that welfare agencies are undertaking to address the need for specialized child care directly. This review does not extend to the full range of the other responses above or to efforts that address issues related to child care policy. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. Our review of these programs suggests that there are at least three broad program strategies to address the barrier found by the need for specialized child care:

Service Coordination. Programs with this strategy aim to institute improved coordination systems or procedures between welfare agencies and other social service agencies in order to help clients obtain specialized child care. One example is the coordination that occurs frequently between welfare agencies and Child Care Resource and Referral agencies (CCR&Rs). Some CCR&Rs pay particular attention to specialized child care needs. CCR&Rs are a natural choice for service collaboration because they are a central structure that provides access for a range of stakeholders. Other forms of service coordination can include computer-based information systems, formal cross-agency advisory groups, or contractual arrangements for child care service provision or provider training.

Increased Service Capacity. Programs with this strategy aim to expand the supply of specialized child care. Included are those that offer incentives for existing providers to increase their hours of operation or that attempt to identify new providers.

Employment Integration. Programs with this strategy include a focus on employment in their efforts at addressing child care needs. Just as some welfare agencies are training clients to operate their own transportation services, some are training clients to become child care providers. Agency efforts could tailor these programs to address the need for specialized child care, though the program we reviewed that trains welfare clients does not (Job Opportunities for Low-Income Individuals, in Lincoln, Nebraska, described later in this section under Program models). The intent of these efforts, in addition to providing employment training for welfare recipients, is also to increase service capacity.

Program Outcomes

Under the new welfare work requirements, large numbers of welfare recipients are likely to need specialized child care, particularly care during nonstandard hours. In 1991, 7.2 million mothers in the labor force worked nonstandard hours, and this number is expected to rise (Bureau of Labor Statistics 1992). Because formal child care arrangements are necessary for parents to work (in the absence of informal care), the logical assumption is that systems that improve coordination of service providers or increase the supply of providers will remove the barrier to employment that lack of child care poses and help some portion of the welfare population become and stay employed.

However, we know nothing about the comparative effectiveness of these efforts. With efforts that seek to expand the supply of specialized child care providers, it would be useful to know the comparative effectiveness of offering direct incentives to providers that train welfare clients themselves to become providers. With efforts that seek to coordinate services, it would be useful to know the comparative effectiveness of relying on external resource and referral agencies to help clients locate acceptable and stable providers versus relying on designated in-house caseworkers. Because the focus to date has largely--and appropriately--been on service provision itself rather than on assessment of service provision, research has not yet included this kind of comparative analysis.

Program Costs

Welfare agency efforts based on coordination of services with existing resource and referral agencies, employers, or other community-based organizations are relatively inexpensive. Because the agency is not providing direct services, most of the cost is for the coordination itself. Some of the expense will be one-time initial costs (for example, for developing relationships and establishing procedures), and some will be ongoing costs (for example, for monitoring client needs and arrangements).

The cost of efforts based on enhanced service capacity--on increasing the actual supply of providers--will depend on the magnitude of effort. The program model that we reviewed, the Centerville Cluster Day Care Diversion Project in Des Moines, Iowa, awarded grants of $20,000 each to two service providers to expand their hours of operation and cover nonstandard hours.

Employment integration efforts, because they increase the supply of child care providers at the same time that they provide training and employment opportunity for welfare recipients, have higher costs. The program model that we reviewed, the Job Opportunities for Low-Income Individuals Project, was funded for $500,000 over three years to train approximately 125 clients. Both employment integration and enhanced service capacity efforts, however, could lead to the creation of enough new child care slots to be cost-effective.

One immediate cost to welfare agencies, however, not exclusive to any particular type of program, is for additional staff resources to serve a growing number of welfare clients who need child care as they enter the workforce. The level of additional resources needed for new staff will depend upon current staffing resources, how operations are organized, and the local supply and demand for child care services. These costs will be incurred whether families need specialized child care or not.

Program Implementation

The summary below discusses implementation issues and approaches that those operating child care programs have faced--and those planning to operate child care programs will likely face--in two key areas: (1) program staff, and (2) local needs assessment.

Program Staff

If program implementation is to be successful, welfare agencies should carefully assess several staffing issues to handle clients' child care needs adequately. Agencies should address at least three implementation issues related to child care staffing. As noted earlier, inadequate attention to the number of staff needed, particularly over time as the number of clients making the transition from welfare to work continues to grow, could cause delays in services, poor matches between providers and clients, or lack of attention to the need for back-up care arrangements. These deficiencies, in turn, place additional demands on staff when clients return for services as current arrangements fail. These demands are likely to be exacerbated when clients need specialized child care.

Determination of the most efficient and effective role for those handling clients' child care needs is also important and will depend upon whether the agency relies on external resources such as a hotline or CCR&R or handles identification of providers and client referrals in-house. Agencies will need to train staff adequately for whichever roles and responsibilities they are expected to assume.

Local Needs Assessment

If programs are to be effective, they should address the specific child care needs that clients face. Effective implementation is dependent upon a clear understanding of what clients need and an inventory of local child care resources. Many of the independent efforts, for example employers' efforts to address their employees' child care needs, begin with some form of local survey. Without clear information about both sides of this issue--client needs and existing resources--it will be harder to develop an appropriate response to address the gap. Some form of local needs assessment will help agencies determine whether they are more in need of coordinated services to make the referral process more efficient (because existing providers meet clients' needs) or more in need of expanded services (because existing providers do not meet client needs). This may be the case, for example, in an area with very few providers offering care during nonstandard hours and a client population in need of this form of care. Because there are few providers and potentially many clients in need of specialized child care, this form of needs assessment must focus on identifying these potential gaps. An initial needs assessment, perhaps conducted in coordination with other local stakeholders, should be done before an agency designs a service response.

Program Models⁽²⁾

• What are welfare agencies doing to address this issue?
• Whom can I contact?

The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

Child Care Support Center

Child Care Solutions

Atlanta, Georgia

Program strategy: Service coordination

Location: One urban site

Iowa Division of Economic Assistance

Centerville Cluster Day Care Diversion Project

Des Moines, Iowa

Program strategy: Enhanced service capacity

Location: Two rural sites

Lincoln Action Program

Job Opportunities for Low-Income Individuals (JOLI) Project

Lincoln, Nebraska

Program strategy: Employment integration

Location: One urban site

Program Name/Contact

Brief Program Description

The Child Care Support Center in Atlanta, Georgia, designed Child Care Solutions (CCS) to help parents find child care in the metropolitan Atlanta area. Although the service is available to any parent in need of assistance, the Child Care Support Center familiar with the unique needs of the welfare-to-work population and seeks to address those needs through specialized programs and through coordination with the Atlanta Department of Family and Children's Services. The center has two goals: (1) to strengthen the ability of families, caregivers, and communities to nurture, support, and educate all children; and (2) to build a supply of affordable, high-quality child care in 16 metropolitan Atlanta counties.

The center operates three programs that affect people moving from welfare to work: CCS, the Lawrenceville Project, and Purchase of Care.

CCS is a child care resource and referral service that provides information, assistance, and training to caregivers and educates parents and the community about the importance of expanding affordable, high-quality child care (with special attention given to nonstandard-hours care, sick-child care, and special-needs child care). CCS notes that the parents' requests for referrals to nonstandard-hours care are outstripping the supply, and the Child Care Support Center has sought to increase the number of caregivers who offer nontraditional care. In addition, CCS maintains data on child care facilities and family child care homes that can offer specialized care for children with disabilities. The cost for referral is determined on a sliding fee scale, according to the person's level of income. While CCS is provided to all residents of Greater Atlanta, its counselors spend substantial time providing child care counseling to the growing number of welfare recipients making the transition to work.

The Lawrenceville Project targets residents of the housing authority for training as child care providers. Project administrators estimate that 95 percent of the program's participants are welfare recipients.

Purchase of Care buys child care for families with children under three at a price of $65 a week. It is funded at $50,000 a year by the Georgia Child Care Council. Families can receive assistance for up to one year. Project administrators estimate that 50 percent of the project's participants are welfare recipients.

Evaluation

This program has not been formally evaluated.

Program Name/Contact

Brief Program Description

The Division of Economic Assistance of the Iowa Department of Human Services and the Iowa Workforce Development Department approved the Community Self-Sufficiency Grant Centerville Cluster Day Care Diversion Project to respond to an identified need for nonstandard-hours child care in the rural counties of Appanoose, Davis, Monroe, and Lucas. The program's goal is to remove the employment barrier of nonstandard-hours care for TANF participants who are participants in PROMISE JOBS, Iowa's work and training program.

The Centerville Cluster Day Care Diversion Project has two main objectives: (1) to expand the number of facilities that provide care during nonstandard hours and (2) to assist TANF/PROMISE JOBS participants in securing nonstandard-hours care. Because of the lack of available nonstandard-hours care, a grant of $20,000 was awarded to Kid's World in Centerville for them to extend their day care hours from 6:00 a.m. to 10:30 p.m. Monday through Friday. Another facility, the Davis County Day Care and Preschool, was awarded a $20,000 grant to provide care from 5:30 a.m. to 10:30 p.m. Monday through Friday. The Davis County Day Care and Preschool has also received $5,000 for open day care during June, July, and August. So that participants can secure nonstandard-hours care, they are advised of the availability of such care at the time of assessment, at the Job Club, and at the negotiation of their Family Investment Agreement. Participants are apprized of the service and its benefits. If a person expresses a need, a formal referral is made to a local area facility that offers nonstandard-hours care.

The program is funded at $50,000 by the Iowa legislature.

Evaluation

While an impact evaluation is not scheduled, the project is undergoing a less formal evaluation.

Program Name/Contact

Brief Program Description

The Lincoln Action Program (LAP), based in Lincoln, Nebraska, has designed the Job Opportunities for Low-Income Individuals (JOLI) Project to address the dual need for employment and child care among welfare recipients and other low-income people. The program's goal is to create 125 new child care or other microenterprise businesses during the program's operational phase (October 1, 1995, to September 30, 1998).

In addition to providing case management, JOLI offers welfare recipients training and support in establishing an in-home child care business. The program provides, at no cost to the participant, more than 50 hours of training in child care-related skill development as well as business management. Financial assistance with business start-up expenses is available to all participants who complete the training series. Additional support and networking opportunities are also provided through monthly support group and business group meetings, as well as a mentoring component that matches successful JOLI child care providers with participants entering the program. The case management services are provided to reduce any existing barriers to self-sufficiency and successful business operation. Family strengths and barriers are identified through a comprehensive assessment. Goal-setting activities follow.

The JOLI Project is funded through the Office of Community Services at the U.S. Department of Health and Human Services. For a three-year period, JOLI was funded at $500,000.

Evaluation

The Center on Children, Families, and the Law, at the University of Nebraska, is currently evaluating this program. The evaluation is designed to measure the program's impact on participants' self-sufficiency through employment or general nonreliance on public assistance, to assess how adequately project activities are implemented (through a process analysis), and to compare the characteristics of people in the JOLI program with people living in the target communities. JOLI staff members will do the actual data collection through interviews and case record review, and the center will analyze the data.

Findings

Results from the final evaluation will be available in October 1988.

Further Information

Further information on issues related to child care is available from the following

Organizations

Child Care Automation Resource Center

Washington, DC

888-821-6997

The Child Care Automation Resource Center was established by the Child Care Bureau of the Administration for Children and Families at the U.S. Department of Health and Human Services to help states and territories meet their reporting obligations under the new welfare reform legislation. The center also provides workshops and training on developing training materials for state and territorial child care staff.

National Association of Child Care Resource and Referral Agencies (NACCRA)

Washington, DC

(202) 393-5501

The National Association of Child Care Resource and Referral Agencies (NACCRA) supports state childcare resources and people and programs that care for children. NACCRA gathers, analyzes, and shares information with families and childcare providers, builds connections in states and communities to create policies on childrens' issues and childcare, and aids families in balancing work and home.

National Association for Sick Child Daycare (NASCD)

Richmond, Virginia

1-804-747-0100

The National Association for Sick Child Daycare supports the establishment of high- quality sick-child daycare programs nationwide, substantiates and quantifies the need for new sick-child programs, promotes the establishment of new sick-child care services by researching and disseminating needed information, and promotes and participates in sick-child care research.

National Child Care Information Center (NCCIC)

Vienna, Virginia

(800) 616-2242

The National Child Care Information Center disseminates child care information in response to requests, conducts outreach to child care providers to connect other organizations and individuals with child care resources, and publishes the Child Care Bulletin.

Further information on issues related to child care is available in the following

Documents

Fewell, Rebecca R. "Child Care for Children with Special Needs." Pediatrics, vol. 91, no. 1, January 1993.

This document discusses child care for children with special needs and places the issue in an historical context. The author reviews the characteristics of young children with special needs, reviews barriers that inhibit provision of care for children with special needs, and notes some current models and practices that have proven effective.

Kamerman, Sheila, and Alfred Kahn. "Child Care In the Context Of Welfare Reform." New York, NY: Columbia University School of Social Work, 1997.

This report discusses the state of child care within the context of welfare reform. In addition to a review of the child care provisions of the Personal Responsibility and Work Opportunity Reconciliation Act, the report presents policy initiatives aimed at reducing the demand for child care, child care funding structures, ways to expand the supply of care, and selected state child care policies.

Kaplan, April. "Child Care and Welfare Reform." Washington, DC: Welfare Information Network, 1997.

This is a fact sheet that provides background information on the child care needs of welfare recipients, as well as on child care publications, resource contacts, and program practices in several states.

U. S. Department of Labor, Women's Bureau. Care Around the Clock: Developing Child Care Resources Before 9 and After 5. Washington, DC: DOL, April 1995.

This document, though it does not focus on either the welfare population or efforts by welfare agencies, addresses the mismatch between changing schedules in the workforce at large and available child care services. The report is designed for those who want to address the growing need for nonstandard-hours care and profiles a variety of efforts--chiefly on the part of employers--to develop appropriate responses.

1. Some states have authorized a higher rate of reimbursement for providers of nonstandard-hours care or have specifically directed resources to these providers (for a discussion of these efforts at differential reimbursement, see Tweedie et al. 1998). These efforts should help to increase specialized care in these states.

2. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."