Quality Rating & Improvement System (QRIS)

sp-qualityA QRIS is a systemic approach to assess, communicate, and improve the level of quality in early childhood and school-age care and education programs.1 Through QRIS, states define what constitutes a higher quality of care based on designated criteria and use a rating system with a recognizable and understandable symbol to communicate to the public how well participating ECE facilities meet these criteria. Many states adopt a “star” rating system, with more stars indicating higher quality.
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QRIS includes five core components: 1) standards, 2) accountability measures, 3) program and practitioner outreach and support, 4) financial incentives specifically linked to compliance with quality standards, and 5) parent and consumer education efforts. For the standards core element, QRIS typically covers categories such as professional development, qualifications, training, and accreditation; parent and family involvement; learning environment; licensing compliance and status; staff compensation; administrative policies and procedures; financial management; and program evaluation. Licensing regulations typically set the floor for these standards, with QRIS defining levels of higher quality that exceed the regulations. As of early 2012, more than half the states and the District of Columbia have implemented a statewide QRIS or similar quality improvement initiative; the remaining states and territories are in the process of developing one.
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There are several ways in which obesity prevention strategies can be incorporated into a QRIS. Examples include:

  • Designating specific nutrition, breastfeeding, physical activity, or screen time standards needed to reach higher quality ratings (e.g., setting a minimum number of minutes per day of physical activity above what is required in state licensing regulations—see Wisconsin state example);
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  • Requiring participating providers to conduct a systematic assessment of their policies and practices related to obesity prevention;
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  • Including technical assistance activities specific to obesity prevention in the set of materials and resources that programs participating in QRIS receive; and
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  • Incorporating obesity prevention information into training and education requirements for ECE providers.
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State Efforts to Address Obesity Prevention in Quality Rating and Improvement Systems by the Altarum Institute provides an in-depth look at how states are currently integrating obesity prevention into their QRIS. The report is based on information gathered in 2011 from a national advisory group; a series of key informant interviews; and a State Teams meeting with officials who were planning or implementing nutrition, physical activity, and/or screen time QRIS standards. The report provides specific examples of the obesity prevention criteria being used, tools and incentives to help ECE providers achieve the standards, and monitoring strategies. It also highlights successful collaborative, cross-agency strategies, challenges states have faced, and recommended next steps in this important policy area.
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State Example: Wisconsin

YoungStar is a program of the Wisconsin Department of Children and Families (WI DCF) dedicated to improving the quality of care for young children in the state through a quality rating improvement system. All ECE facilities in the state that serve children birth to 5 years are eligible to enroll in YoungStar. All programs that receive child care subsidies are required to participate in YoungStar and receive a star rating. ECE facilities are awarded up to five stars based on points earned for creating safe environments and encouraging healthy behaviors based on four categories of standards:

  • Education qualifications and training;
  • Learning environment and curriculum;
  • Professional and business practices; and
  • Child health and well-being practices.

These elements are evaluated on the basis of established, measurable standards. ECE facilities enrolled in YoungStar are evaluated annually and must display their stars in a window and post the YoungStar certificate on a wall.

In the child health and well-being practices category, YoungStar requires that all facilities rated three stars or higher earn one point for serving nutritious meals and snacks. To verify that nutritious meals and snacks are served, facilities must demonstrate that they participate in the Child and Adult Care Food Program, provide 3 months of menus for review by a nutrition professional, or receive a score of five (Good) on the Early Childhood Environment Rating Scale (ECERS)-Revised. Facilities can earn optional health and wellness points for providing at least 60 minutes of physical activity each day, with elements of outdoor time, provider-led, music and movement, active transitions, tummy time, and limited use of restrictive equipment for infants being met.  The point for physical activity is verified through observation, lesson plans and the daily schedule.

How It Came About

In developing the wellness components of YoungStar, the WI Department of Health Services’ Nutrition, Physical Activity and Obesity Program, in collaboration with the WI DCF and additional key stakeholders, spent many years laying the groundwork. Over time, the program earned overwhelming support from elected officials, ECE providers, and ECE advocates.  For details about how the program came to be, including the 5-year plan for the program, please visit the website.

Implementation

The YoungStar program was implemented first with targeted training opportunities delivered to 12 counties, and through pilot projects administered in each region of the state (Together Quality Grows and Grow in Quality) before going statewide. This implementation approach allowed the DCF to gain additional support from stakeholders and fine-tune the program.

In the fall of 2010, more than 5,000 ECE providers received specialized training related to quality improvement in the ECE environment, professional practices, and/or child health and wellness in these counties. That November, a contract was issued to the YoungStar Consortium, an organization made up of the Celebrate Children Foundation, the Supporting Families Together Association, and the Wisconsin Early Childhood Association, to administer YoungStar to ECE facilities in all six regions of the state (72 counties and 11 tribes). An intensive launch training for the Technical Consultants and Rating Observers was held. The DCF developed policy criteria related to star level quality indicators, created support materials, and established baseline protocols that were required to be met in each region. In December 2010, ECE facilities began to enroll in the YoungStar program and receive ratings. In March 2011, a year after DCF Secretary submitted the plan to establish a QRIS, Secretary Eloise Anderson sent a final report on YoungStar to the Joint Finance Committee. After that, the YoungStar program was officially launched in the state.

In addition to technical assistance, micro-grant funds are awarded to actively participating ECE facilities based on a self-assessment and a quality-improvement plan developed in consultation with the programs’ Technical Consultant. To help implement and disseminate the YoungStar program, the DCF developed an online directory, allowing parents to search for YoungStar-rated providers. See here for additional information.

Lessons Learned

  • Ensure opportunities for ECE provider and parent stakeholders to offer input.
  • Create and support opportunities for ECE providers to access needed training and technical assistance.
  • Ensure credits are available for certifications, credentials, and degrees.
  • Communicate frequently with the ECE workforce about quality indicators and make the indicators and related information accessible online (points detail, FAQ, minimum points, training calendar).
  • Ensure that communications meet language and cultural needs of ECE providers.
  • Demonstrate how nutrition and physical activity strategies can be woven into larger systems-level ECE changes.

 

References

  1. NCCIC. QRIS Resource Guide. (2010). Available from http://qrisnetwork.org/sites/all/files/resources/gscobb/2011-12-15%2006:10/QRISResourceGuide.pdf. Accessed 2012 Feb 13.