By Kay Ducharme, Regional CCR&R Senior Manager at Child Care Services Association
Part III: Why is data important?
For Child Care Services Association (CCSA), collecting data about the impact and effects of high quality child care is one of the most important things we can do for early childhood educators, young children and families. To that end, we talk to educators and families daily, collecting an enormous amount of data to analyze the needs of families and early childhood educators. In fact, we are the only organization in North Carolina that collects data on child care supply and demand. This information helps us strengthen and innovate the child care system for families, child care providers, programs and communities.
Yet, I am often asked why we have to
collect all of this data. In short, data is absolutely vital to ensuring that
all children have access to high quality child care led by educated and
For example, recent data indicates decreases in the number of classrooms, family child care homes and the total number in the child care workforce. Since child care resource and referral (CCR&R) is the only system that collects data on both supply and demand, we continue to help families locate child care as the supply decreases and the need increases. We also work to help start-up new programs to fill gaps where the supply of child care is limited. Our data can be used to help us advocate for change in public policy. And we need data to accurately tell the story of what families and providers across North Carolina need to strengthen services for families and the early childhood education field.
Federal funds to support CCR&R are a part of the Child Care Development Block Grant (CCDBG). The state’s Division of Child Development and Early Education (DCDEE) defines goals each year for the Council to help North Carolina meet federal block grant requirements. Regional CCR&R Lead Agencies receive funding from the Council to provide services in the 14 CCR&R regions based on population, community and child care demographics, workforce numbers and number of classrooms in the region, etc. The Council reports outcomes, outputs and demographics to DCDEE each year. These reports enable us to analyze customer needs and identify gaps in services and trends in each of North Carolina’s 100 counties.
Statewide in FY19, the NC CCR&R
system data indicated that the 14 regions trained 24,180 early educators; 3,077
of those training participants received CEUs. In addition to training,
CCR&R agencies provided technical assistance to 6,171 classrooms/homes and
consumer education and/or consultation to 21,738 households across the state. Ninety-eight
percent (98%) of families surveyed said they used quality indicators when
choosing child care and 97% of the families surveyed indicated that they chose
a 3-5 star rated child care program after using CCR&R services. By
collecting data in a consistent manner using defined data sets, data is
monitored to ensure reliability.
To access a membership to the website for
CCR&R staff, please contact Mary Erwin, NC CCR&R Council Coordinator at
Child Care Services Association, here.
For more in-depth knowledge of the
CCR&R system, training sessions are available each year throughout the
state for new staff. The final one for this fiscal year will be held in
Greenville, N.C., at the Martin-Pitt Partnership for Children, April 23 at 9:30
a.m. You can register for the training session here.
To read the first part of this series on what the statewide CCR&R is, click here.
To read the second part of this series on what the NC CCR&R Council is, click here.
By Marsha Basloe, President, Child Care Services Association
During a child’s earliest years, brain development occurs that sets the architecture for all future learning (e.g., the wiring needed for healthy child development across social, emotional, physical, and cognitive areas). This is what makes high-quality child care for infants and toddlers so important.
At the same time, infant and toddler care is the hardest to find. The supply of infant and toddler care pales in comparison to the needs of working parents. A report by the Center for American Progress found that 44 percent of families in North Carolina live in a child care desert where the demand for child care by working families far exceeds the supply.
Even when families can find it, too many struggle with the cost, particularly for infants and toddlers. Throughout North Carolina, the average annual price of child care for an infant in a child care center is $9,254. The average annual price of child care for an infant in a family child care home is $7,412.
perspective, for a single mother earning minimum wage ($7.25 per hour) working
full-time, she would earn $15,080 per year. The cost of center-based infant
care would be 61.4 percent of her income. The cost of infant care in a family
child care home would be 49.2 percent of her income. If she earns twice the
minimumwage ($14.50 per hour), about $30,160 per year – the cost of
child care in a center would be 30.7 percent of her income. The cost of infant
care in a family child care home would be 24.6 percent of her income. If she earnsthree times the minimum wage ($21.75 per hour), her annual income would
be about $45,240 per year. Center-based infant care would cost 20.5 percent of
her income; infant care in a family child care home would cost 16.4 percent of
To help families with the cost of child care, the North Carolina Division of Child Development and Early Education (DCDEE) offers qualifying families a subsidy. The state pays most of the cost and families have a 10 percent co-pay. Unfortunately, not all families who qualify can receive assistance and more than 30,000 eligible children throughout the state are on a waiting list for child care financial help. It is important to note that the waiting list is only a snapshot in time because some families don’t join the list when they hear about the length of it. So, the waiting list reflects only those who qualify for help and who also add their names to the waiting list in case more funding becomes available to support additional families.
For families with infants
and toddlers, the supply and cost are both struggles. It’s unrealistic to think
that families can access the licensed market if they have to pay a huge
percentage of their income to cover the cost. Why is that a concern to all
North Carolina taxpayers? There are several reasons.
Quality of child care and long-term taxpayer bills. When parents can’t afford the licensed market, if they must stay in the workforce to make ends meet, then they will try to make do with a variety of unlicensed care options. Given the brain development that is underway during a child’s earliest years, it is critical that a child be in a setting that promotes his or her healthy development. That’s one of the reasons for the rated child care license in North Carolina and one of the reasons the NC General Assembly restricted the receipt of child care subsidies to programs with at least a 3-star rating. Supporting healthy child development is important, particularly for infants and toddlers when the brain is developing the fastest. Taxpayers will pay more in the long-term when a child enters kindergarten without the skills to succeed through additional costs for remediation, for special education, and for those children who must repeat a grade (e.g., repeating a grade is not “free”).
Labor force participation. Without affordable child care, parents reduce their hours or opt-out of the workforce. Ninety-four percent of workers involuntarily working part-time due to child care problems are women. In North Carolina, 457,706 children under age 6 have working parents. If one-third to one-half of these children under 6 are infants and toddlers, that’s 151,043 to 228,853 children who may need some type of child care while their parents work.
Employers & Employees. Employers depend on working parents. And, working parents with young children depend on some type of child care.
As the General Assembly meets to
discuss budget priorities, child care assistance should be at the top of the
list. Given the extraordinary cost of child care for infants and toddlers, the
General Assembly may want to consider reviewing other models to support access
to high-quality infant and toddler care.
In June 2018, the District of Columbia City Council unanimously passed the Birth to Three for All DC Act. The legislation charts the path for a comprehensive system of supports for children’s healthy growth and development with a specific focus on services for families with infants and toddlers. The Act is broad — investing in home visiting and child developmental screening, however, with regard to child care for infants and toddlers, the Act expands child care subsidy eligibility for infants and toddlers to all families by 2027, caps the percentage of annual income a family would pay toward child care expenses at 10 percent of gross income by 2028, and phases in competitive compensation for early educators. The District is now in its second year of implementation with $16 million in funding for FY2020. City Council members say it’s a high priority to increase funding as part of the 2021 budget, and work on that front is underway.
There are certainly differences
in passing legislation that supports a city (even a large city like Washington,
D.C.) compared to a state. However, the concept is innovative. It recognizes
that the cost of infant and toddler care is so high that all families may
struggle with the cost. It recognizes that access to high-quality infant and
toddler care is important to a child’s healthy development. And, it recognizes
that a compensation strategy for the child care workforce is needed to support
It is time to rethink the state’s
approach to child care subsidy, and especially how families with infants and
toddlers are supported in accessing high-quality child care. In the new year,
let’s give thanks for what we have and think through policies that can best
support our children in the future.
Jennifer Gioia, Communications Manager at Child Care Services Association
on November 20, since 1954, the world celebrates Universal Children’s Day to
spread awareness of improving child welfare worldwide, promoting and
celebrating children’s rights and promoting togetherness and awareness amongst
all children.  With Thanksgiving so close, we would like you to
join us in taking a moment and thanking those who work tirelessly every day to
improve the lives of our youngest children.
Whether that’s a parent, an early childhood
educator, a doctor, child care provider, government leader, grandparent,
volunteer, nurse, religious leader, an advocate for children, or a friend, we
at Child Care Services Association (CCSA) thank you for your dedication and
leadership to ensuring the mission that every child deserves access to
affordable, high-quality child care and education.
high-quality early childhood education?
High-quality early childhood education is
critical to a child’s development by creating a stimulating, safe and loving
environment for children birth to 5.  “A high-quality program
uses teaching approaches that support a child’s learning and curriculum goals.
Teachers modify strategies to respond to the needs of individual children, and
provide learning opportunities through both indoor and outdoor play.” 
“Quality programs are comprehensive.” 
High-quality child birth-to-five programs have lasting boosts in cognition and
socio-emotional skills driving better education, health, social and economic
outcomes.  Research shows that “high-quality birth-to-five
programs for disadvantaged children can deliver a 13% return on investment,”
which means children are more likely to graduate high school, go to college,
have a family and live a happier, more successful life. 
On Giving Tuesday (December 3), consider
investing in our children—our future. At Child Care Services Association, we’re
all about children. From helping children build healthy behaviors in what they
eat and how they play to making sure their teachers are qualified, trained and
adequately paid, CCSA focuses on a child’s early years, aiming to make them
happy, stable and secure.
all children have that start—a healthy foundation—we all do better.
Children are happier and more ready to enter
school, parents are secure in knowing their child is being cared for and
educated in a stable environment, and early childhood educators have the
resources they need to continue their education and can support their families
while pursuing the career they love.
At CCSA, we’re also all about making sure all
children have that healthy foundation. To have that healthy foundation, all
children need more stable relationships with better-educated and fairly
compensated teachers that stay in their jobs.
In fact, research shows that early experiences
are particularly important for the brain development of children of color and
children from low-income families.
“The highest rate of return in early childhood
development comes from investing as early as possible, from birth through age
five, in disadvantaged families. The best investment is in quality early
childhood development from birth to five for disadvantaged children and their
At CCSA, we use research, services and
advocacy to build a healthy foundation for every child because we believe all
children deserve the best start at their best life.
you invest in high-quality early childhood education?
Give to CCSA today! Your gift may help support
a parent who is starting a new job through our referral and scholarship programs
or a child care teacher who wants to finish an early childhood education degree
through our scholarship and compensation programs.
Our work results in enormous benefits for
children, families and the community. Help us make sure every child has a good
start to lifelong learning in a safe, nurturing, quality environment.
by Jennifer Gioia, CCSA Communications Manager
In October 2016, Michelle Roach received a
call on a Tuesday morning—she would be fostering Jordan, a 6-day-old baby. “I
wasn’t really prepared for actually searching for [child care],” Michelle said.
“I’m a solo parent, so it was a big adjustment to do that, and as soon as he
came into the home, we had a clock ticking. We had eight weeks at home with him
and then he needed to find somewhere to go during the day.”
Parents often need a place to start as they begin their child care search. This is where Child Care Services Association’s Child Care Referral Central comes in. Child Care Referral Central is a trusted resource for families looking for child care, helping them find care based on their needs and providing information and resources at their request.
“We are in a unique position to link families,
child care providers and the community together, so that parents can get all
their child care answers in one place,” said Christy Thalheimer, referral
manager at CCSA’s Child Care Referral Central.
“By going to Child Care Services Association,
it really did allow me to have one place where I could ask my questions,”
Michelle said. “I could get more information about both center-based [child
care] but also family-based [child care]. I was able to sit down with a counselor
and talk about what resources I had available to me, the subsidy through [the
Department of Social Services] and what was available in the community.”
CCSA’s referral counselors can walk a family
through all their child care options at each age of their children. From infant
care to after school care, CCSA’s Child Care Referral Central can provide the
tools families need to find the right child care for their children.
Often people see child care resource and
referral programs (CCR&Rs) as only available to families who are most at
risk due to poverty or special circumstances. While the Department of Social
Services (DSS) offers a Child Care Subsidy program that uses state and federal
funds to provide subsidized child care services to eligible families, finding
the right child care is an important piece of the work-life puzzle for every
family, no matter their income. Community members often ask if services are
only for those in financial need, but CCSA’s Child Care Referral Central is
available to every family in the nine-county area of Alamance, Caswell, Durham,
Franklin, Granville, Orange, Person, Vance and Wake counties.
Silvana Rodriguez was Michelle’s child care
counselor at Child Care Referral Central. She has been a counselor for more
than seven years.
“[Michelle] walked into the office…and then told me that she was a first time parent, she was going to receive an infant and she was nervous about the whole process,” Silvana said. “So, I answered all of her questions. She had several questions about the types of care, the differences between them, and then I did a [customized] search for her based on [her work and home addresses]…We talked about national accreditation and what
to look for, and then after that, we made a package for her with all the
different information that may be useful for her.”
“One of the things, it was so small but it helped me so much, was that all of that information was placed in one packet and handed to me,” Michelle said. “In the chaos of my life of having a newborn and figuring everything out, having this one place I could go back to with all the phone numbers and all the information about ratings and other really helpful things in one spot made something that could have been really overwhelming more manageable. I was able to periodically when I had the time, make phone calls, set up tours and narrow down where he ended up going between two really high-quality centers. I picked one that was closer to my work, and I was really happy with the results from that.”
Silvana loves helping families like
“That’s the thing that drives all us counselors because you can see the results when you follow up with them, and especially when they find a great quality place, and just going through their options and helping them navigate everything in terms of finding child care,” Silvana said.
“[CCSA’s Child Care Referral Central] made the
already challenging process of being a solo parent and figuring out the process
of DSS and foster care, and also just the challenge that every parent faces
when they have to go back to work, which is that you’re leaving your tiny human
being with other people, to really make that easier and to make me feel better
about that process and more comfortable with him being there and knowing that
he would be cared for in a reputable space,” Michelle said. “I didn’t have the
pressure of having to Google or guess. I had all that information in one spot,
and for me, that really made all the difference.”
Jordan turns three at the end of next month.
He’s is “graduating” from Early Head Start and will transition over to another
classroom in the same center mid-August. Michelle has thought about reaching
out to CCSA again to speak with a counselor about more child care options. “I’m
hoping to participate in the Universal Pre-K program next August,” Michelle
You can hear more about Michelle’s story by
watching the video below.
PED was right – addressing the achievement gap requires much more attention to a child’s earliest years. While Pre-K expansion was recommended, research points to the birth to age 3 period of a child’s life as the time when the largest impact on a child’s development is possible. This period of early childhood must also be taken into account as we plan for the future for all NC families.
PED was charged with reviewing school districts nationwide with high poverty rates and at least average achievement by students to see if there were common strategies that could be used within North Carolina school districts. The project addressed three research questions,
are the characteristics of school districts that have high percentages of
economically disadvantaged students yet demonstrate high academic performance?
policies or practices are high-achieving disadvantaged districts implementing
that may contribute to student performance?
policies or practices could North Carolina implement in order to improve
performance in districts with high percentages of economically disadvantaged
The results were sobering. PED found that local school districts throughout the country struggled in attaining grade level or better student performance. In fact, PED identified only 5% of predominantly economically disadvantaged school districts that also had grade level or better student performance over a 7-year period. Within North Carolina, 45 of 115 school districts were identified as predominantly economically disadvantaged, which is about 39% of North Carolina school districts. Of those 45 school districts, only 7 (about 16%) met the bar of student performance at grade level (or above). While higher than the national average, 16% is nothing to boast about.
What PED found was that within economically disadvantaged school districts where students are performing well (at grade level or above), third grade is an important marker. Student growth occurs after 3rd grade but that efforts to address student competencies before grade 3 are most important in reducing the achievement gap.
PED conducted interviews within 12 economically disadvantaged school districts (comparable to school districts within North Carolina) with grade level (or above) student performance to see if there were any common strategies that led to higher student outcomes. One of the factors that the 12 school districts had in common was a significant investment in public pre-kindergarten (pre-K). Pre-K in two of the school districts (Durant Independent School District in Oklahoma and Steubenville City Schools in Ohio) target both three- and four-year-old children for enrollment. Four of the five North Carolina counties in which case study districts were located had 75% or more of eligible children participating in NC Pre-K.
However, PED notes that current funding enables only 47% of low-income eligible children statewide to participate in NC Pre-K.
The PED report makes two
Recommendation #1. The General Assembly should require low-performing school districts to include an early childhood improvement plan as a component of their required plans for improvement. PED calls for the development of specific strategies aimed at boosting achievement from pre-K to 3rd grade and lists expanding pre-K, improving pre-K quality, ensuring alignment of pre-K curricula with elementary school curricula, developing transition plans, providing professional development that focuses on early learning and providing instructional coaching focused on pre-kK through 3rd grade.
Recommendation #2. The General Assembly should require an assessment of early childhood learning as part of the Department of Public Instruction’s comprehensive needs assessment process for districts.
While those of us who have worked in the early childhood education field are glad to see the recommendations related to pre-K, and agree the NC Pre-K program should be fully-funded so all eligible children have an opportunity to participate, children are not born at age four.
Research shows that pre-K makes a difference in a child’s school readiness, particularly for low-income children. However, that same research also notes that a child’s gains in pre-K are directly related to his or her prior experiences before pre-K.
Neuroscience research shows that a child’s earliest years, from birth to age three, play a critical role in the development of brain wiring that lays a foundation for all future learning. In the first years of life, more than one million neural connections are formed every second.
This wiring frames the architecture upon which all future abilities are built. While people learn throughout their lives, a child’s earliest years are critical because they set the foundation. Genes and experiences help shape a young child’s brain development, which begin long before a child enters pre-K. And, remediation strategies are much more difficult as children (and adults) age.
According to the U.S. Census
Bureau’s latest data, throughout North Carolina:
356,007 children are under age three
465,783 children are under age six who also have working parents (young children residing in two-parent families where both parents work or in a single-parent family where the head of household works)
Young children with working mothers are in child care every week for about 36 hours according to the Census Bureau. Most of these children are not age four; they are not in pre-K. This is why any directive to the General Assembly to address the achievement gap, which rightly calls for addressing the early childhood landscape, has to not only focus on access to pre-K but also must focus on access to high-quality child care and the early childhood workforce that cares for our youngest children.
We applaud PED’s call for low performing school districts to include an early childhood improvement plan and an assessment of early learning opportunities as part of district comprehensive needs assessments. However, early learning is not limited to pre-K settings. High-quality child care programs are important early learning settings at all ages. Any needs assessment and early childhood improvement plans that are derived from such a landscape review must include our youngest children. Child development, school readiness and reducing the achievement gap depend on it.
By Linda Chappel, Vice President, Triangle Area Child Care Resource and Referral Services at Child Care Services Association
This week the Best of The Triangle 2019 was published in INDYWEEK, naming most favorite activities, foods and events voted on by readers and described as the “wisdom of the crowd.” I present the Best of the Triangle as Durham PreK.
In 2018, the Durham County Commission voted to make historic local investments to open access for more 4-year old children to high quality preschool services. At a time when North Carolina’s legislators are talking about funding virtual preschool, Durham is boldly creating face-to-face opportunities for children with local funds.
A primary goal of Durham PreK is supporting the learning and development of young children to improve the quality of their lives now and in the future. We know from years of research that high quality preschool enhances children’s school readiness by providing substantial early learning, which can have lasting effects far into a child’s later years of school and life.
Research finds high quality preschool programs can accomplish this goal by producing large and lasting gains in outcomes such as “achievement, educational attainment, personal and social behavior (e.g., reductions in crime), adult health, and economic productivity.” These gains are broad and last long into adulthood.
The importance of funding pre-K in Durham
At CCSA, our research found there are six low-income preschool children for every one publicly funded preschool space in Durham through programs such as NC Pre-K, Durham Public Schools and Head Start.
Currently, more than 25% of Durham census tracts with more than 50 low-income preschoolers have no publicly funded preschool slots. In a random survey of approximately 2,000 Durham parents, 92% of parents rated cost-free preschool as desirable or essential. 
Durham PreK benefits the community
While a child’s success in school and life
addresses our society’s greater good, children from lower-income households are
often left behind, furthering inequality and setting the stage for the
achievement gap that persists through high school. As a vibrant, growing
community, Durham recognizes the short- and long-term benefits of attendance in
a high quality early childhood program for children, their families and the
These benefits range from reduced need for
special education services or remedial support during the K-12 years to
increased tax revenue and reduced dependency on government assistance in
adulthood. Researchers quantified these benefits and found a return on
investment of $3-$13 for every dollar invested in early childhood. Even at the
low end of this estimate, this is a significant return.
With an abundance of evidence that high-quality universal preschool could reduce the disparities in skills among subgroups of children at kindergarten entry, Durham’s policymakers are focusing considerable resources on the development and expansion of quality preschool programs for 4-year-olds.
Durham PreK will help improve the quality of early education in Durham County by improving classroom instruction, supporting family engagement and building capacity for high quality through practice based coaching, while expanding access to publicly funded preschool services for all the county’s 4-year-olds. A critical component of this initiative is the implementation of preschool classrooms in diverse settings, including public schools and community-based programs. Durham PreK provides teachers and directors with regular coaching and professional development on cultural competence and social-emotional learning and conducts quality improvement activities to enhance children’s classroom experiences.
Unlike many programs around the country,
Durham PreK requires teachers hold a Birth to Kindergarten teaching certificate
and that they be paid at the same salary level as teachers in Durham Public
Schools. Durham PreK places this emphasis on the teachers’ compensation to
attract and retain the most qualified teachers.
Our overall goal in Durham is to improve the quality of and access to preschool programs for more children. We started with an ambitious two-year plan that runs through July 2020. We know this will be a journey that builds each year until we can serve all Durham’s children and ensure their life-long success. Durham PreK plans to stay Best of the Triangle.
 Phillips, D.A., Lipsey, M.W., Dodge, K.A., Haskins, R., Bassok, D., Burchinal, M.R.,…Weiland, C. (2017). Puzzling it out: The current state of scientific knowledge on pre-kindergarten effects, a consensus statement. Washington, DC: Brookings Institution. Downloaded July 24, 2017 from https://www.brookings.edu/wp-content/uploads/2017/04/consensus-statement_ final.pdf
 Durham Supply and Demand Study, Child Care Services Association, (2018). https://www.childcareservices.org/research/research-reports/early-childhood-system-studies/
 Phillips, D. A., et al. (2018). The changing landscape of publicly-funded center-based child care: 1990-2012. Children and Youth Services Review, 91, 94-104; Cascio, E. U. (2017). Does universal preschool hit the target? Program access and preschool impacts. Cambridge, MA: National Bureau of Economic Research; Yoshikawa, H., et al. (2013). Investing in our future: The evidence on preschool education. New York: Society for Research in Child Development and the Foundation for Child Development.
Millions of Americans live with mental illness. With May just passing as National Mental Health Awareness Month, it is important to recognize that prevention and early intervention are the solutions to a healthier, happier life. 1The National Alliance on Mental Illness records 1 in 5 (46.6 million) U.S. adults experience mental illness at least once in their lifetime, and “half of all lifetime mental health conditions begin by age 14 and 75% by age 25, but early intervention programs can help.” 2
One dependable way to intervene and prevent mental illness is recognizing it as early as possible, since even infants and young children can have mental and developmental disorders. 3 Healthy social and emotional development is the foundation for brain development in young children, and high-quality early care and education is a large piece of that development.
With this high-quality child care and education, infants and
toddlers, “who engage with responsive, consistent and nurturing caregivers, are
more likely to have strong emotional health throughout life.” 3
Supports such as T.E.A.C.H., WAGE$ and AWARD$ help child care teachers further
their education and receive additional compensation, allowing them to continue
teaching and caring for our youngest children.
While having happy, educated and stable teachers improves
the quality of care and education a child receives, child care can still be unaffordable
for parents, especially if they have more than one child in need of care. CCSA’s
free child care referral services simplify the child care search, helping parents
focus on what’s truly important for their specific child’s needs without worrying
about another expense. “Ensuring all families
have access to affordable, high-quality child care can help mitigate some of
the impacts of poverty and prepare children for success in school and beyond.” 4
However, even with affordable and positive early childhood
experiences and stable educators, mental health and developmental delays can be
seen as early as infancy. 3
“Children can show clear characteristics of
anxiety disorders, attention-deficit/hyperactivity disorder, conduct disorder,
depression, posttraumatic stress disorder, and neurodevelopmental disabilities,
such as autism, at a very early age. That said, young children respond to
and process emotional experiences and traumatic events in ways that are very
different from adults and older children. Consequently, diagnosis in early
childhood can be much more difficult than it is in adults.” 5
It is important to identify and treat mental health
disorders as early as possible to reduce impairment, suffering and effects on
overall health and development. 3
However, it can be difficult to identify mental health illness in young
children, and parents may turn to their child’s doctors or teachers for
guidance. “If properly identified using diagnostic criteria relevant to infant
and early childhood development and experiences, many of these challenges can
be effectively treated.” 3
“It is clear that state agencies [also] must attend to the
mental health needs of infants and young children if they want to improve
health and developmental outcomes, prevent impairment due to early adversity,
provide trauma-informed care, and ultimately, see better returns on investment.
Adopting an age-appropriate diagnosis and treatment is a significant step
toward assuring better overall health for infants, young children, and their
and the teachers who educate and nurture our youngest.