	Background

States are responsible for developing licensing criteria and health and  safety requirements and conducting enforcement activities to ensure  providers comply with them and thereby protect the safety and health of  children in child care settings. While the federal government’s role is  limited in this area, the states must certify that they have safety and health  requirements in place and procedures to ensure providers comply with all  applicable requirements to receive federal CCDF funds. The Child Care and Development Block Grant statute that underlies the  CCDF requires states to designate a lead agency and to establish state  plans that commit to establishing and enforcing licensing requirements  and health and safety standards for child care providers. Most states conducted compliance inspections at least once a year,  which met or exceeded the recommended level for all types of providers. The Number of States Exempting Some Family Child Care Remained about the Same

According to the data reported through state surveys and NCCIC, one less  state exempted family child care providers-–sole caregivers who care for  children in a private residence other than the child’s—than were exempted  from health and safety requirements in 1999. In 1999, 39 states exempted  some family child care providers from regulation, and by 2003, 38 states  were exempting some of these types of providers. Many Inspection Staff Are Organized by Geographic Location, and Technology Is Used in Most Parts of the Licensing and Inspection Process

While 43 states assigned staff to a geographic location, those states using  this broad method varied in the specifics of such assignments. Nineteen  states also reported assigning staff based on specific job task, such as  responding to complaints. Some states used multiple criteria to organize their staff; these  states frequently first assigned staff based on geographic location and then  relied on secondary criteria, such as type of child care facility. Forty-five states reported using technology to assist them with many  aspects of licensing and enforcement activities. Promising Practices in Technology, Rating Systems, and Training

States we visited have adopted a number of promising practices to assist  in their child care licensing and enforcement activities. First, some states  used technology in ways that allowed them to streamline their licensing  and enforcement processes and to manage parent and provider  information particularly effectively. Rating Systems Helped Parents Choose Child Care and Offered Providers Incentives to Improve and Maintain the Quality of Child Care

Florida, North Carolina, and Oklahoma have implemented rating systems  to tie the level of reimbursement to a provider’s quality. The use of technology has also increased in the states for state licensing  staff, providers, and parents. With the information we gathered through these expert interviews, we  identified and conducted site visits in four states—Delaware, Florida,  North Carolina, and Oklahoma—to provide examples of promising  practices in licensing and enforcement. Child Care: State Efforts to Enforce Safety and Health Requirements. GAO/HEHS-00-28, January 24, 2000.
Why GAO Did This Study

The federal government requires states that receive funds from the Child Care and Development Fund to establish basic health and safety requirements. The federal government also requires states receiving federal funds for child care to have procedures in place to ensure that providers being paid with grant dollars comply with the applicable safety and health requirements. Because of the significant federal role in paying for child care services and congressional concerns about the way in which states ensure the safety and health of children in child care settings, we were asked to follow up on our prior report, Child Care: State Efforts to Enforce Safety and Health Requirements (GAO/HEHS-00-28, Jan. 24, 2000). This report (1) identifies changes in states' licensing and enforcement activities for various types of licensed and nonlicensed providers since 1999, (2) describes the ways child care licensing agencies organize inspection staff and use technology, and (3) provides examples of promising practices in state child care licensing and enforcement activities. To obtain data, we surveyed state licensing officials in 2004 about their 2003 activities, interviewed experts and made site visits to four states--Delaware, Florida, North Carolina and Oklahoma.

What GAO Found

State efforts in the licensing and oversight of child care facilities are generally about the same as they were in 1999, except that the median caseload of the number of facilities per inspector dropped from 118 to 110 in 2003. We found that in 2003, 38 states exempted all family child care providers from being regulated, compared with 39 states in 1999. Most states conducted compliance inspections at least once a year, meeting or exceeding the recommended level for all types of providers. Many states organized inspection staff by geography and used technology in many parts of the inspection process. Forty-three states reported assigning staff to geographic locations throughout the state. States also assigned staff based on specific job task and type of child care facility the staff would inspect. Many states used multiple criteria to assign staff. Forty-five states reported using technology to assist them with many aspects of licensing and enforcement functions, such as maintaining statistics on families and providers. States have adopted a number of promising practices to assist their child care licensing and enforcement activities. These practices include the use of technology to streamline licensing and enforcement processes and manage parent and provider information, rating systems to aid parents in selecting the appropriate child care for their child and to offer providers incentives to improve and maintain the quality of their care, and working with other organizations to train providers and parents.