FIRST THINGS FIRST
The mission of First Things First is to increase the quality of, and access to, early childhood programs
that will ensure a child entering school comes healthy and ready to succeed. This mission will
principally be achieved through regional grants tailored to the specific needs and characteristics of the
communities the region serves, and with a focus on demonstrating how improved outcomes around
the six goals will be attained given the challenges the region faces.
In November 2006, the voters of Arizona passed First Things First, a statewide ballot initiative that
funds a voluntary system of early childhood development and health. With a dedicated annual funding
stream generated from a tax on tobacco products, First Things First aims to achieve the following
goals:
• Improve the quality of early childhood development and health programs;
• Increase access to quality early childhood development and health programs;
• Increase access to preventive health care and health screenings for children through age five;
• Offer parent and family support and education concerning early child development and literacy;
• Provide professional development and training for early childhood development and health
providers;
• Increase coordination of early childhood development and health programs and public information
about the importance of early childhood development and health.

Submitted in accordance with ARS 8-1192. The Early Childhood Development and Health
Board shall conduct a biannual assessment of existing early childhood development
and health programs in the State of Arizona, including an analysis of any unmet early
childhood development and health needs of Arizona children, utilization of available
Federal, State and private funds, suggestions for improved program coordination, and
outcomes for children and families. The Board shall submit a report of its findings
and recommendations to the Governor, the President of the Senate and the Speaker of
the House of Representatives on or before December 15 of every odd-numbered year
beginning in 2007 and shall provide a copy of this report to the Secretary of State and
the Director of the Arizona State Library, Archives and Public Records. The report shall
be distributed in accordance with section 41-4153.

Arizona Early
Childhood
Development and
Health Board

Arizona Early Childhood
Development and Health Board
Chair – Nadine Mathis Basha
Vice Chair – Gary Pasquinelli
Member – Rhian Evans Allvin
Member – Paul Luna
Member – Steve Lynn
Member – Hon. Cecil Patterson Jr.
Member – Dr. Pamela Powell
Member – Vivian Saunders
Member – Dr. Eugene Thompson
Ex-Officio Members
Susan Gerard – Director, Arizona Department of Health Services
Tracy Wareing – Director, Arizona Department of Economic Security
Amy Corriveau – Deputy Associate Superintendent, Arizona Department of Education

First Things First 2007 BUILDING BRIGHT FUTURES





First Things First 2007 BUILDING BRIGHT FUTURES

Letter from the Board Chair
Building Bright Futures, the first in a series of assessments conducted every other
year for First Things First, the Arizona Early Childhood Development and Health Board,
provides a snapshot of the current state of early childhood in Arizona. This document
will create a baseline that allows us to measure our progress, as well as determine how
best to invest resources that will improve the lives of young children and their families.
Building Bright Futures provides direction at the community level as well. The report
will serve as a tool for Regional Partnership Councils in helping them create the types
of programs that give families real choices about their children’s educational, health
and developmental experiences, while enhancing the quality and accessibility of those
programs.
This report is based on a year’s worth of work reviewing available data as well as listening
to parents, educators, child care providers, health professionals and community leaders
regarding the assets and needs they have in their communities. Building Bright Futures is
divided into three main sections. The first section provides an overview of key education and
health indicators of children’s readiness for school and life. The second section describes
the current condition of the system of early care and education in Arizona, and is organized
around the funding areas of the First Things First initiative: quality, access, health, family
support, professional development, public information/awareness and system
coordination. The last section of the report offers recommendations for all interested in
enhancing the future outcomes for Arizona’s youngest children.
Our vision is that Arizona will be a state where all of our children enter school healthy
and ready to succeed. To achieve this vision and to fulfill the promise made to the voters
of Arizona by the passage of First Things First in 2006, it is imperative to know where
we stand today. This is a start. We hope you will join our efforts as we work together to
build a stronger foundation for a future where every Arizona child has an opportunity for
a successful, healthier quality of life.

Nadine Mathis Basha
Chair, First Things First

First Things First 2007 BUILDING BRIGHT FUTURES



Acknowledgements
Our sincere appreciation to the following individuals and organizations that provided the expertise, time, and
information necessary to define the current early childhood development and health environment and create
a vision for what is possible for Arizona’s young children and their families:
The Voters of Arizona – who approved the implementation
of Proposition 203, First Things First, and demonstrated
their commitment to investing in and promoting the
success of Arizona’s youngest children.
Parents and Grandparents – who provided first-hand,
inspiring accounts of the strengths of Arizona families
and children and the challenges they have encountered in
meeting the needs of their children and grandchildren.
Service Providers – who, day in and day out, provide
needed services and supports to children and families, and
who contributed insight into the challenges of providing
services, the unmet need, and the future directions.
Key Informants – who, as providers of early childhood
services, providers of professional development services,
philanthropists, advocates, and state administrators,
helped define the infrastructure needed to create a
results-oriented, family-focused system of early childhood
development and health.
Private Funders – who offer their vision, commitment to
quality services for Arizona’s children and families, ongoing
financial support, and insight into the definition of infrastructure
for a high-quality, sustainable system of early childhood
development and health.



First Things First 2007 BUILDING BRIGHT FUTURES

Arizona Early Education Funds Regional Partnerships –
who shared their experiences in building local partnerships
in support of early education and for the vital connections
they provided to individuals and organizations who helped
define the assets, barriers, and priorities for an Arizona
early education system.
Governor Napolitano and Staff and Members of the
State School Readiness Board – who developed the
nationally recognized School Readiness Action Plan,
which has served for four years as the blueprint for
community organizations, state agencies, and private
funders to plan and implement projects relating to early
care and education. Their work will continue to serve as the
foundation for implementing a high-quality early childhood
system focused on supporting families, programs and
schools, teachers, and communities.
State Agency Staff – who, as the professionals of the
Arizona Department of Health Services, Arizona Health
Care Cost Containment System, Arizona Department
of Education and the Arizona Department of Economic
Security, provided detailed information about current
funding, services, and results for early childhood
development and health programs in Arizona.
First Things First Staff – who shared their experience and
expertise in the development of the statewide Needs and
Assets Assessment and who listened and learned from
community participants across Arizona.

Table of Contents
Introduction

6

Building Bright Futures

9

Arizona’s Young Children and Families

12

Child and Family Indicators
A Growing Population
Race, Ethnicity and Language
The Changing Family Composition
Employment, Income and Poverty
Parent Educational Attainment
Healthy Births
Healthy Children – Insurance Coverage and Utilization
Child Safety
Children’s Educational Achievement
Conclusion

15
16
16
16
18
19
19
19
20
20
21

Arizona’s Current Early Childhood Development and Health System

22

Quality
Access
Health
Family Support
Professional Development
Public Information and Awareness
System Coordination

25
35
43
55
63
71
79

Arizona’s Opportunity

84

The Right System for Bright Futures

87

Appendix

90

Development of the Needs and Assets Assessment Report
Endnotes

93
95

First Things First 2007 BUILDING BRIGHT FUTURES





First Things First 2007 BUILDING BRIGHT FUTURES

INTRODUCTION
First Things First is focused on building a
community-driven, results-oriented early
childhood system supportive of all children
birth through age five. This report, Building
Bright Futures, begins that process. First
looking at how children are faring, and then
reviewing the status of the state’s current
programs and services, the report outlines
Arizona’s challenges but ultimately shows
there is much opportunity for change.

First Things First 2007 BUILDING BRIGHT FUTURES



Introduction

“We

envision

a

nation

that

supports

the

healthy

development of all children within their states and
communities by providing comprehensive, coordinated,
well-funded systems of high-quality, prenatal-to-five
services that foster success in school and life.”
Matthew Melmed, Executive Director,
Zero to Three, 2007



First Things First 2007 BUILDING BRIGHT FUTURES

Introduction

Building Bright Futures
First Things First presents Arizona with the unprecedented opportunity to create an
early childhood system that affords all children an equal chance to reach their fullest
potential, gives families real choices about their children’s educational and developmental
experiences, and includes every community in sharing the responsibility as well as the
benefits of safe, healthy and productive citizens. Investment in young children results in a
stronger Arizona and contributes to the economic growth and well-being of the state.
Ultimately, the aim of First Things First is to improve developmental and early learning
outcomes for young children ages birth through five years. To achieve that goal, First
Things First, with its community partners, will work to build a system that grows and
sustains a coordinated network of early childhood programs and services. The charge
of First Things First is to design a system in which programs and services are of highquality, easily accessible, and affordable by all who wish to access them. Creating such
a system allows Arizona to lead the way for improving children’s chances for success.
In January 2008, the Board will embark on the task of strategic planning. To effectively
shape policy decisions, the board must first be fully informed of the current status of
Arizona’s children. This report is to be used as a tool as the board designs a roadmap for
change for the state’s current early childhood system. Through the collection of baseline
data, a synthesis of community input, and an analysis of what is missing in the current
system, this initial report begins to outline possible options for identifying priority activities.
The intent is that the report acts as a resource of information illustrating how children
and supporting services in Arizona are faring. Opportunities for change are provided for
consideration based on the analysis of the data and what current research indicates is
necessary for building an early childhood system.
It is important to note the challenges in writing this report. While numerous sources for data
exist in the state, the information was often difficult to analyze. Lack of a coordinated data
collection system among the various state agencies and early childhood organizations
often produced statistical inaccuracies and duplication of numbers. Additionally, many
indicators that could effectively assess children’s healthy growth and development

First Things First 2007 BUILDING BRIGHT FUTURES



Introduction

are not currently or consistently measured. The identification of future indicators to
gauge progress toward First Things First goals will be an important outcome of the
strategic planning process. Once these measures are established, First Things First has
the opportunity to create a home for the accurate collection and statewide sharing of
children’s data.
In subsequent years, the Needs and Assets reports will include information regarding
progress on the established indicators that arise out of strategic planning. These later
documents will also serve as a tool to guide other policy-makers and early childhood
leaders in formulating future decisions related to young children and families.

Today in Arizona
Arizona faces many challenges in guaranteeing all children are healthy and ready for
success. Based on the data and information collected throughout this report, there is not
only room for improvement in the state’s current early childhood development and health
system, there is substantial reason to be concerned. Arizona’s opportunity is to create the
change necessary that will ensure every child’s future is bright. To do so requires building
on the system infrastructure, strengthening quality programs and services currently in
place, and designing strategies around the identified gap areas in Arizona services.
Arizona is challenged by a lack of high-quality early care and education programs
available to all who wish to access them. Only 15% of early care and education centers
are accredited by the National Association for the Education of Young Children 1 and less
than 1% of home-based settings are accredited by the National Association for Family
Child Care. 2 These numbers indicate there are a limited number of settings that meet a
set of identified quality criteria.
Arizona is challenged by the high cost of early care and education. Almost one in four
Arizona children birth through five lives in poverty.3 Just as startling is that almost six out
of ten Arizona families live just above poverty,4 but not making a wage that allows them
to receive any form of assistance. These families can neither afford quality early care and
education, nor can they afford health care.
Arizona is challenged by a growing number of children birth through five who have
no access to health care due to lack of insurance coverage. At the current population
rate, over 109,000 children birth through five have no health insurance.5 That number
exemplifies 109,000 children without dental care, 109,000 children not receiving

10

First Things First 2007 BUILDING BRIGHT FUTURES

Introduction

preventive well-child care, 109,000 children not receiving immunizations, and 109,000
children not receiving care when they are sick.
Arizona is challenged by its capacity to assure all families are wellinformed about early literacy and its importance to children’s future
language development. Parent literacy and how often children are
read to at home are strong predictors of children’s future literacy
success. Arizona families lag behind national averages for daily
reading activities and many families lack the skills necessary to
provide strong literacy support to their children.6
Arizona is challenged by an underpaid and unskilled early
childhood workforce. Currently, only about one-third of early
childhood education teachers have a four-year degree or
beyond.7 Additionally, early childhood professionals enter and
leave the field at a rapid pace due to poor compensation and
a lack of professional support.8
Arizona is challenged by the lack of a coordinated system that
provides accurate early childhood information to families from
many backgrounds and locations across the state. The high number
of rural areas and significant differences in family needs create challenges
for families seeking information regarding child development, parenting, and
the availability of quality child care. Families often lack awareness and understanding
of where to find the information they need, or it is in formats not easily understood by all
who need it.
Arizona is challenged by the lack of both a national and a statewide database for
the accurate collection and management of children’s indicator data. Currently data
collection is disjointed or often conducted at a state agency level only. Information needed
to track children’s progress may not always be available, complete, or accurate.
Arizona faces numerous challenges in ensuring all children are healthy and ready to
succeed. But these challenges are not insurmountable. Arizona now holds an opportunity
to build a system that changes outcomes for children and gives all families the choices
they deserve.

First Things First 2007 BUILDING BRIGHT FUTURES

11

12

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Young
Children and
Families
First Things First is focused on building a
comprehensive early childhood system so all
Arizona children will begin school with the
skills they need for long-term educational
and personal success. The following section
provides an overview of key social and health
indicators that will present a statistical
portrait of Arizona’s children.

First Things First 2007 BUILDING BRIGHT FUTURES

13

Arizona’s Young Children and Families

“An accumulating body of evidence suggests that early
childhood interventions are much more effective than
remedies that attempt to compensate for early neglect
later in life.”
James Heckman
Nobel Laureate in Economic Sciences,
University of Chicago

14

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Young Children and Families

Child and Family Indicators
Child and family indicators illustrate children’s health and readiness for school and life
and provide policy makers, practitioners and the community with a measurable way to
understand child and family strengths and needs. The indicators included in this section
were selected based on current research about what makes a difference in improving
outcomes for young children and their families. They include the following:
• Early childhood population – race, ethnicity, language, and family composition
• Economic status of families – employment, income, poverty and parents’
educational attainment
• Trends in births
• Heath insurance coverage and utilization
• Child safety – abuse and neglect and child deaths
• Educational achievement – fourth grade performance and high school
graduation
While First Things First may not have a direct effect on these or other indicators, they
are important measures to track because they outline a picture of a child’s chance for
success. In addition, some indicators such as child abuse, child neglect, and poverty,
are being tracked because they provide pertinent information on how children are faring.
These indicators provide information on potential service or system changes that may be
necessary for First Things First to have the greatest impact possible.

A Growing Population
Arizona’s population growth is outpacing that of the nation. From July 2000 to July 2006,
Arizona’s population grew from 5,130,693 to 6,166,318, a rate of 20.2% as compared
to a nationwide population growth rate of 6.4%.9 Along with this overall increase in
population, came tremendous growth in the number of children birth through five years.
From July 2000 to July 2006, the number of Arizona children ages birth through five
years increased by 25% to 576,938 and now represents 35% of Arizona’s total child
population.10 If Arizona’s growth continues near or at the current pace, there will be more
than 600,000 children in Arizona under age six by 2010.11

First Things First 2007 BUILDING BRIGHT FUTURES

15

Arizona’s Young Children and Families

Race, Ethnicity and Language
The racial and ethnic composition of Arizona’s early childhood population has also
changed since 2000. Five percent more children birth through five years were identified
as being ethnically Hispanic/Latino in 2006 than in 2000, while the share of total children
identified as White (not Hispanic/Latino) dropped by 4% in 2006 compared to 2000.12
Twenty-two percent of children under age six are children of immigrants; however, 93%
of these children were born in the United States.13 Among people over five years of age
living in Arizona in 2006, 28% spoke a language other than English at home. Of families
reporting using a primary language other than English at home, 77% spoke Spanish,
7% spoke an Indo-European language, 6% spoke an Asian/Pacific Island language, and
10% spoke some other language.14
In 2000, there were 21 federally recognized Indian tribes in Arizona with 37,521 families
and 21,216 children ages five and under. One percent fewer children birth through five
were identified as American Indian in 2006 compared to 2000. Among tribal populations,
18% (8,517) of the households considered themselves linguistically isolated. Of the
tribal population over age five, 94,711 individuals (58.6%) indicated they speak a Native
American language at home.15

The Changing Family Composition
The number of young children living in families with two married parents has increased
since 2000. Families with at least one child under age six grew from 209,069 to 217,600,
a 4% increase from 2000 to 2006. However, this number has decreased from 232,027
in 2005.16
The percentage of young children living in single parent households, though fluctuating
slightly over the last five years, has remained around 30% between 2000 and 2006.
The number of single male householders with at least one child under the age of six
increased by 15% from 2000 to 2005, and the number of single female householders
with at least one child under the age of six increased 31% from 2000 to 2005.17 Thirtynine percent of families living on tribal lands with at least one child under age six, were
single parent households in 2000, a higher rate than the general population.18, 19 While the
percentage of the young child population living in single parent households has remained
fairly constant, the population increase among children birth through five, means there
are now more young children living in single parent households.

16

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Young Children and Families

The birth rate for females 19 or younger increased from 28.1 births per 1,000 in 2005,
to 29.6 births per 1,000 in 2006 although the teen birth rate had steadily declined over
the past 10 years from 37.8% in 1996.20 Research indicates that children of teen
mothers are more likely to be born with low birth weight, suffer poor health,
experience behavior problems, and have limited language and literacy
skills.21 Teen mothers are less likely to have the financial resources,
social supports, and parenting skills to fully support their children’s
development.22
Grandparents are increasingly finding themselves responsible for
raising their young grandchildren. In 2005, an estimated 30,400
children birth through five years lived with a grandparent who
was the primary caregiver.23 Furthermore, the estimated number
of children birth through five living with a grandparent as the
caregiver with no parent present went from 4,500 children in 2005
to

an

7,600

estimated
in

2006.24

Based on the 2000
Census,

slightly

over

6,000 grandparents living
on tribal lands were responsible
for their own grandchildren under
the age of 18.25

Grandparents

raising

grandchildren

experience some unique conditions.
Grandparent caregivers are more likely to
be poor compared to parent-maintained families. The 2000 Census showed that 19% of
grandparent caregiver households were below the poverty line as compared to 14% of
households with parents.26 Furthermore, a portion of grandparent caregivers have either
disabilities or age-related functional limitations that affect their ability to respond to the
needs of grandchildren. In 2006, 37% of grandparents (60 years old or older) living with
grandchildren had a disability.27

First Things First 2007 BUILDING BRIGHT FUTURES

17

Arizona’s Young Children and Families

Employment, Income and Poverty
The unemployment rate for Arizona as of August 2007 was 3.8%.28
This is a continual decline since 2002 when the rate was 6%.
More than half (57.2%) of the 309,242 families with children
under six years of age in 2006 had all parents in the family in
the labor force, an increase from 53.4% in 2000.29 While
the unemployment rate has continued to drop, the total
number of families in Arizona who live in poverty rose
by 23.6% between 2000 and 2005.30 Almost 160,000
families, 10.9%, live at or below poverty in Arizona.31 A
total of 29% of American Indians in Arizona had incomes
below federal poverty guidelines.32 Families living in
poverty have less access to quality care environments,
affordable health care, and support systems that ensure
children grow healthy and enter school ready to learn.
Arizona families have significantly lower annual incomes than the
rest of the nation. With 59% of Arizona families having a median
family income of less than 200% of poverty, Arizona is ranked 41st in
the country.33 This indicates that a family of four living in Arizona is likely to
have an income of less than $40,000 per year.
More Arizona children under the age
of six lived at or below poverty in 2006
than in 2000 — an increase from 21% to
22.2%.

34

While the number of children

under age six increased by 24.9%, the
number of children under age six living
below poverty increased by 32.1% to
124,407.35 Children living in poverty are at
greater risk for incurring negative health
impacts and developmental problems.36
Children experiencing poverty between
age two and five are more likely to score
lower on verbal tests than other children
and are more likely to experience
behavior problems that impact their learning experiences.37

18

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Young Children and Families

Parent Educational Attainment
Sixteen percent of Arizona families have less than a high school diploma (includes all
parents and primary caregivers living in the home).38 While the percentage of children
born in Arizona to mothers without a high school education decreased slightly from
2000 to 2005, it remains significantly high at 30% compared to a national rate of 22%.39
Nearly 8% of all Arizona births in 2005 were to teenage mothers who had not completed
high school.40 The educational level of a child’s mother is a strong predictor of the
academic achievement, health status, and well-being of her children. 41 Mothers without
a high school diploma are less likely than mothers with a high school diploma to provide
enriching early childhood experiences for their children birth through five years.42 Children
of mothers without a high school diploma score lower on tests of math and reading skills
upon entry to kindergarten than children of mothers with a high school diploma.43

Healthy Births
The total number of births in Arizona has significantly increased over the years, doubling
from 50,049 in 1980 to 102,042 in 2006.44 The percentage of births to Arizona mothers
who received late or no prenatal care is declining but exceeds the national rate of
3.6%.45, 46 Prenatal care contributes significantly to a healthy birth. Women who do not
receive early and continuing prenatal care have double the risk of delivering a premature
baby and are three times more likely to deliver a baby with a low birth weight.47
Infants with low birth weight (5.5 pounds or less) and babies born pre-term are at greater
risk for physical and developmental problems than full-term infants and babies of normal
weight.48 In 2005, 6,640 children, (6.9% of all births), were born weighing less than 5.5
pounds.49 In 2006, the number increased to 7,266 or 7.1% of all births.50

Healthy Children – Insurance Coverage and Utilization
Arizona has made significant headway in improving access to well-child visits for
Medicaid eligible children and in increasing child immunizations. But a troubling portion
of the state’s youngest children still have no access to regular health care due to lack
of insurance coverage. In 2005, the percentage of Arizona’s children ages birth through
five without health insurance rose to 19% from 15% between 2003 and 2005.51 This
compares to 11% of children birth through five without health insurance nationally.52
Families with health insurance are more likely to receive well-child visits, prenatal care
and up-to-date, routine immunizations that prevent health problems as well as ongoing
care to address chronic health issues.53, 54 The percentage of Arizona children ages 1935 months who have been fully immunized increased from 72% to 81% between 2000
and 2005, just below the national rate of 82% for 2005.55
First Things First 2007 BUILDING BRIGHT FUTURES

19

Arizona’s Young Children and Families

Child Safety
Child abuse and neglect are strongly linked with negative outcomes for children including
poor school performance, frequent grade retention, juvenile delinquency, and teenage
pregnancy. Children who have been neglected, physically abused, or sexually abused
are more likely to exhibit cognitive and emotional problems.56 Although Arizona’s rate
of child abuse and neglect of 4.7% per 100 children was considerably lower than the
national rate of 11.5% in 2004, the Arizona rate increased 1.5% between 2003 to 2004.57
As of March 2007, Arizona children under the age of five in foster care/out-of-home
care represented almost 40% of the total (9,773) number of children in out-of-home
placements.58
Child deaths have increased since 2000 and children under four years represent 68% of
the total deaths in 2007 for children under age 18.59 In 2006, 90% of unexpected infant
deaths identified unsafe sleeping environment as a contributing preventable factor (n=81).
Unsafe sleeping position was a contributing preventable factor in 50% of unexpected
infant deaths (n=45).60

Children’s Educational Achievement
Young children who receive the support they need and deserve from ages birth to five
score better on academic tests when they enter school, are less likely to require special
education services, are held back a grade less often , and are more likely to graduate
from high school.61
Children who cannot read well by fourth grade are more likely to miss school, experience
behavior problems, and perform poorly on standardized tests.62 The performance of
Arizona’s children on standardized tests continually lags behind that of the nation. Fiftysix percent (56%) of Arizona’s 4th graders scored “at basic” or better on the 2007 NAEP
Reading Assessment, compared with a national average rate of 67%.63 The percentage
of Arizona 4th graders achieving “at basic” or better on the NAEP Math Assessment
increased dramatically from 57% in 2000 to 74% in 2007, but Arizona’s 4th graders still
score 8% below the national rate of 82%.64
The completion of high school is a critical juncture in a young adult’s life. Students who
stay in school and take challenging coursework tend to continue their education, stay
out of jail, and earn significantly higher wages than their non-graduating counterparts.
According to Kids Count 2006, Arizona’s high school dropout rate has improved from
18% in 2000 to 9% in 2005, but still exceeds the 2005 U.S. rate of 7%.65

20

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Young Children and Families

Conclusion
This statistical portrait of Arizona’s early childhood population indicates that there are
multiple risks impacting Arizona’s youngest children and their opportunities to reach
their fullest potential. These risk factors must be taken into account when making
policy decisions so the current system is strengthened. Tracking these social and health
indicators over time will allow for the community as a whole to be continually informed of
the status of Arizona’s youngest children.

First Things First 2007 BUILDING BRIGHT FUTURES

21

22

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Current
Early Childhood
Development and
Health System
The First Things First initiative identifies
several individual areas of focus. Each goal
area is a piece of a larger picture and is
inextricably interrelated and linked with the
others. In this section, the state’s assets, gap
areas, and recommendations are outlined
and organized within the initiative’s goal
areas. The descriptions are presented with
the underlying assumption that each of the
goals reinforces the others.

First Things First 2007 BUILDING BRIGHT FUTURES

23

Arizona’s Current Early Childhood Development and Health System

“The science of child development tells us that significant
variations in the quality of early care and education
programs

have

the

potential

to

produce

lasting

repercussions for both children and society as a whole.”
Jack Shonkoff and Deborah Phillips
From Neurons to Neighborhoods: The Science of Early
Childhood Development, 2000

24

First Things First 2007 BUILDING BRIGHT FUTURES

Arizona’s Current Early Childhood Development and Health System

Quality

What is the status of quality in early
childhood development programs in Arizona?

The Arizona Picture
Background
Families deserve choices. Every Arizona child should be afforded the opportunity to
receive care and education in a high-quality setting that promotes optimal growth and
development. During the past 15 years, considerable research on brain development has
demonstrated how important the first years of life are to a child’s growth, readiness for
school, and success throughout life. For children who spend much of their time in care
settings outside of the home, opportunities to stimulate learning and curiosity in their early
care and education environments is crucial. Research shows that children who participate
in high-quality programs begin school with higher reading skills, better test scores, and
fewer behavioral problems. These are the very skills they need to be ready to succeed.
Conversely, and perhaps even more importantly, mediocre or low-quality early care and
education can have the opposite effect. Children attending programs not considered
high-quality can have poor intellectual and social development.66 Understanding the
effects of early care and education quality is vital in developing an early childhood system
that produces positive outcomes for children’s growth and development.
However, quality care is difficult to find in Arizona because many of the settings throughout
the state do not meet what national experts describe as necessary to promote positive
outcomes. Although the actual level of quality in Arizona early care and education settings
cannot be fully determined, most programs strive only to meet the regulations required
for obtaining a license. These requirements are minimal in Arizona and do not include
issues of quality such as optimal adult to child ratios, maximum group sizes, highly
skilled personnel, or nurturing and engaging environments. Because these licensing
requirements are minimal and do not factor in quality practices, many of Arizona’s children
are cared for in settings where quality is poor.
Families throughout the state recognize the need for high-quality early care and education,
but struggle to locate care that meets even basic health and safety standards. Ensuring
children have quality experiences is a high priority for Arizona communities, and although
there are some settings which meet high-quality expectations, they are not equitably
available to all Arizona children.

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Arizona’s Current Early Childhood Development and Health System

Early childhood experts have outlined the attributes of high quality that lead to positive
outcomes. Characteristics of a high-quality program include:
• High staff to child ratios
• Small group sizes (the maximum number of children in a group, regardless of the
number of adult staff)
• Directors and teachers with high levels of experience, training and education
• Environments that encourage children to explore, develop curiosity, and actively
participate in their learning
• Staff members who nurture and engage children in a variety of learning
experiences
• Administrative practices that support effective staff development, supervision, and
leadership
• Parent involvement that is encouraged and supported
• Environments and practices that maintain children’s health and safety
Any effort to understand quality begins with the recognition that standards provide the
foundation for identifying what a state values and envisions as important for young
children’s experiences. First, a state must have program standards that outline what
environments, teaching practices, and learning opportunities should look like. Two
types of program standards are regulatory standards and quality standards.
Arizona currently has no statewide, accepted set of quality standards, but
licensing regulations (for center-based programs) and certification regulations
(for group homes regulated by Department of Health Services [DHS], and
group homes accepting Department of Economic Security [DES] child care
subsidy) are the state’s regulatory standards that define the minimal health
and safety requirements for regulated settings.
In addition to program standards, effective early childhood development
systems include early learning standards that provide a set of agreed
upon outcomes for children. Having standards for children provides guidance to
teachers and other professionals in designing activities for children’s learning. Early
learning standards outline what children should be learning and are the indicators to be
measured when looking at children’s progress.

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Quality

Regulatory Standards

Quality Standards

Early Learning Standards

Program standards that outline
minimal health and safety
requirements for all licensed
programs. Example: All outlets have
plugs; Staff wash hands before
serving meals.

Program standards that outline
indicators necessary for assuring
an early childhood environment
meets the level of high-quality
that is known to affect positive
outcomes for young children.
Example: Staff who provide
instruction hold bachelor’s degrees;
Staff interactions with children are
positive and nurturing.

Standards for children’s learning
that outline agreed upon goals
for young children. These are the
desired outcomes for children who
attend early care and education
settings. Example: Child identifies
and describes feelings of others;
Child identifies letters in familiar
words, including those in own name.

Standards are regulated by a state
agency.

In Arizona Today
How often a setting is monitored for compliance with the state’s minimum health and
safety standards depends greatly on the number of licensing staff available relative to the
number of licensed facilities. At the very least, all children in Arizona should be cared for
in safe, healthy, and nurturing environments. However, families in Arizona face challenges
in locating care in which they can have confidence that their children’s settings meet
even basic health and safety requirements.
Currently in Arizona, there are too few staff funded that can monitor licensed programs
and assure all children are in environments where they are safe. Caseloads are higher
than recommended and therefore, monitoring cannot occur with enough frequency to
make certain a child care center or group home is in continuous compliance with even
basic health and safety regulations.

The ratio of licensing surveyors to regulated sites was 1:87 in 2005, 1:82
in 2006 and 1:78 in 2007. The National Association for the Education of
Young Children (NAEYC) recommended ratio is 1:50.67

86% of DHS licensed child care centers have been monitored within the
required time frame for 2007. The remaining 373 licensed centers and group
homes do not receive compliance visits within the appropriate timeline as
required by statute.68

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Arizona’s Current Early Childhood Development and Health System

In addition to basic health and safety, research has identified a set of key determinants
that identify characteristics of high-quality early care and education and distinguish
between those that are of high-quality and those that are of poor quality. Two important
factors which greatly affect a child’s experiences are adult to child ratios and group
sizes. Assuring children are supervised effectively to maintain their health and safety,
and providing them with individualized attention requires an appropriate number of
adults. Licensing regulations in Arizona require adult to child ratios set at higher than
recommended levels and do not align with what research indicates result in children’s
positive growth and development. Group sizes are also a concern when considering
whether children are receiving a high-quality experience. Regardless of the number of
adults per number of children, if group size is too large, children cannot receive a level of
care necessary for assuring the positive outcomes that arise out of participating in highquality programs. Child care licensing regulations in Arizona do not stipulate any limits on
group size other than what the classroom activity space can accommodate based on 25
square feet per child. The result is children cared for in classrooms where there are too
many children for high-quality learning opportunities to exist.

Adult to Child Ratios:

Arizona Licensing Versus Recommended Standards 69
Child Age Range

Arizona Licensing
Adult to Child Ratio

Recommended
Adult to Child Ratio

Birth to 12 months

1:5 or 2:11

1:3

1 year olds

1:6 or 2:13

1:4

2 year olds

1:8

1:5

3 year olds

1:13

1:7

4 year olds

1:15

1:8

Maximum Group Sizes:

Arizona Licensing Versus Recommended Standards 70
Child Age Range

28

Arizona Licensing
Maximum Group Size

Recommended
Maximum Group Size

Birth to 12 months

No Maximum

6

1 year olds

No Maximum

8

2 year olds

No Maximum

10

3 year olds

No Maximum

14

4 year olds

No Maximum

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Quality

One attribute of a high-quality early care and education program is the attainment of
a nationally recognized accreditation. Families in Arizona have limited choices when
searching for care that is accredited, and therefore considered higher quality. The
National Association for the Education of Young Children (NAEYC) is considered by those
in the early childhood education field to be the gold standard in accreditation for
center-based settings. The National Association for Family Child Care (NAFCC)
accredits family child care settings. Few programs in Arizona have received
NAEYC or NAFCC accreditation. Most center-based programs that
have been accredited are located in public school settings with limited
space and limited eligibility.

15% of Arizona’s licensed early care and
education centers have been accredited
by NAEYC. 71
Less than 1% of child care homes in
Arizona have been accredited by the
National Association for Family Child Care
(NAFCC).72

Too few accredited programs are available to provide equitable opportunities
for all of Arizona’s children to receive high-quality care. Licensing standards that
provide only a minimal set of health and safety requirements do not address the quality
issues that research indicates are of utmost importance. Low ratios of licensing surveyors
to the number of programs licensed result in ineffective and untimely monitoring of basic
health and safety standards.
Beyond licensed care, many children in Arizona attend care that is neither licensed nor
regulated. Often children receive care in settings that are exempt from state regulations
because current law allows individuals caring for fewer than five children for compensation
to operate without a license. Additionally, many children are cared for in unregulated
settings. The level of quality in these programs is unknown. Improving opportunities for
all children to experience high-quality early care and education is a priority for Arizona’s
families.

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Arizona’s Current Early Childhood Development and Health System

Arizona’s Assets
Arizona has begun the process of creating a system that values high-quality early care and
education experiences for children. In continuing this process, it is important to identify
the current strengths and assets upon which Arizona can further enhance quality.
Arizona maintains regulatory standards for minimum health and safety as well as provides
guidelines for program standards that align with indicators of quality such as environment,
teaching practices, and teacher qualifications.

Regulatory Standards
Asset Item

Agency Responsible

Description

Child Care Licensing Regulations

Department of Health Services
(ADHS) – Office of Child Care
Licensure

Set of minimum health and safety
requirements for center-based and
regulated home-based early care
and education settings.

Child Care Home Certification
Regulations

Department of Economic Security
(DES), Child Care Administration

Set of minimum health and safety
requirements for home-based early
care and education settings that
contract with DES.

Asset Item

Agency Responsible

Description

Comprehensive Guidelines for Early
Childhood Programs

Arizona Department of Education

Set of standards for early childhood
programs to assure quality
environments, instruction, and
administration.

Head Start Performance Standards

Federal Department of Health and
Human Services

Set of federally determined program
implementation and administration requirements for Head Start
programs and agencies.

National Health and Safety Performance Standards: Guidelines for
Out-of Home Child Care Programs

National Resource Center for Health
and Safety in Child Care

Set of national health and safety
standards established through
collaboration of the American
Academy of Pediatrics, the
American Public Health Association,
and the Maternal and Child Health
Bureau of the U.S. Department of
Health and Human Services.

Quality Standards

One of Arizona’s strongest building blocks for high-quality early care and education is
the availability of Arizona Early Learning Standards. These standards are considered by
experts in standards development to be a model set of learning standards for young
children ages 3-5.

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Quality

Early Learning Standards
Asset Item

Agency Responsible

Description

Arizona Early Learning Standards

Arizona Department of Education
(ADE)

Set of agreed upon goals of
what children ages 3-5 can and
should be able to do upon exiting
preschool.

Further strengthening Arizona’s opportunity to move toward higher quality services for
children are the various pilot projects and programs conducted by agencies throughout
the state. These activities inform good practice in designing a system that will ensure
all children have quality experiences available to them. Building on existing programs
allows for the use of others’ knowledge and assists in avoiding duplication of ineffective
activities.

Steps Taken to Improving Quality
Asset Item

Agency Responsible

Description

Enhanced Rate for Accredited
Programs

Department of Economic Security
(DES) – Child Care Administration

10% increase over and above the
contracted child care subsidy rate
provided to nationally accredited
centers and homes.

Early Childhood Quality Improvement Arizona Department of Education
Practices Process (ECQUIP)

Required system of ongoing program assessment and improvement
for all early childhood programs
administered through ADE.

Arizona Self-Study Project

Department of Economic Security
(DES), Child Care Administration

Statewide project that assists programs in self-assessment, quality
enhancement, and progress toward
national accreditation.

Arizona’s Early Childhood Inclusion
Coalition

Self-governed

Grassroots cross agency initiative to
promote inclusive options for young
children with disabilities and with
the goal to improve the number of
preschool students who receive
services in inclusive environments.

Pinal County Pilot Quality
Improvement Project

Governor’s Office for Children, Youth Using Workforce Investment Act
and Families
(WIA) grant funds and in collaboration with Central Arizona College,
short-term pilot of a quality improvement program.

“First Focus on Kids” Five Star
Quality Rating System Pilot

United Way of Tucson and Southern
AZ / Governor’s School Readiness
Board

Using an Early Learning Opportunities Act grant, a two-year pilot for
a five star quality improvement
and rating system focusing on
professional development, parent
education, improved literacy activities, and health and safety technical
assistance.

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Arizona’s Current Early Childhood Development and Health System

What’s Missing

32

Gap in Service

What it Means

Financial resources limit staffing
abilities of state agencies which
oversee health and safety standards.

Insufficient numbers of staff do not ensure that all licensed
care and education facilities receive the number of monitoring
visits as required by statute or that would provide for minimal
assurances of children’s health and safety.

Licensing regulations outline the most
minimal health and safety standards
for programs with no regard to quality
issues such as effective adult-child
ratios or maximum group sizes.

Licensing regulations that do not require any level of quality
allows programs to be in compliance with minimal state health
and safety standards, but not address quality issues. This
means that children may be receiving care in settings of low
quality which adversely affects their intellectual and socialemotional growth.

Licensing regulations require no
education beyond high school
for teachers and only require the
equivalent of a single college course
for directors.

Low educational and professional requirements for child care
settings do not promote the recruitment or retention of skilled
or trained adults to work with young children. Teachers caring
for the youngest children may have no more than a high school
diploma and 6 months experience with children.

There are no statewide quality
standards in place by which Arizonans
can measure or ensure nurturing
environments, parental involvement,
effective adult/child interactions or
other indicators of high quality.

Lack of quality standards means the state has limited ways of
ensuring a program’s level of quality. Without a clear picture
of quality, programs do not know what standards they need to
achieve. Having a set of quality standards would provide the
basis for a statewide system that measures, improves, and
rates program quality.

Although Early Learning Standards
exist, few early care and education
settings are required to use them,
nor are all early childhood teachers
trained sufficiently to use them
effectively. In addition, there are no set
standards developed for the infant and
toddler population.

Limited numbers of children participate in early care and
education settings that provide quality learning opportunities
that ensure they will be ready for school success.

First Things First 2007 BUILDING BRIGHT FUTURES

Quality

Arizona’s Opportunity for Change
A limited number of high-quality early care and education programs may be found
throughout Arizona, but there is no system to ensure that this level of quality is available
to all families and their young children. To achieve this goal, the elements of quality must
be understood by both providers and consumers, and there must be a coordinated
system of early care and education which supports higher standards of quality.
Quality early care and education results when highly qualified professionals are providing
services, and there exists a clear set of well-designed quality standards for recognizing
and measuring the quality of the settings in which children participate. Using established
standards for children and programs, as well as identifying measures of quality through a
program improvement and rating system, are essential in developing the infrastructure
necessary for an effective early childhood development and health system. The following
are possible strategies to enhance quality services:

1.
2.
3.
4.

Raise or develop regulatory standards for all early care and education settings
to address fundamental quality issues, including changes to adult-child ratios,
group sizes, and professional education and training requirements.

Effectively and consistently monitor early care and education programs by
ensuring an appropriate number of licensing surveyors.

Provide financial support, incentives and technical assistance for programs to
meet enhanced standards and/or to become nationally accredited.

Provide ongoing incentives for programs to use the Early Learning Standards
and implement evidence-based approaches to achieve quality outcomes for
their programs and the children being served.

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Arizona’s Current Early Childhood Development and Health System

“Whether or not families have access in their communities
to information, health services, quality care and early
learning opportunities, and other resources can directly
impact children’s readiness for school.”
The National Governors Association,
Final Report of the NGA Task Force on School Readiness,
Building the Foundation for Bright Futures, 2005

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Arizona’s Current Early Childhood Development and Health System

Access

What is the status of accessibility to early
childhood development programs in Arizona?

The Arizona Picture
Background
Accessibility to high-quality early care and education is a concern for many Arizona
families with young children. Families often face many barriers to obtaining
service that is high-quality, available and affordable. Having access to highquality care requires that it is both available and affordable. Beyond
the limited numbers of high-quality programs, Arizona families often
face many barriers to obtaining care for their children. Specifically,
many families cannot afford the cost of services, cannot reach
these services due to distance or lack of transportation, or
cannot locate services that meet their needs related to
hours or ages of children served.
Current data suggests that nearly 60% of children ages
birth through five have all parents in the workforce.
But what is unknown is how many of those families
require child care or education services. Limitations
in data collection related to enrollment in regulated
care, and a lack of data related to unregulated care,
create challenges for accurately assessing the supply
and demand of services. Although data collection is
problematic, Arizona’s communities have indicated that
accessibility to quality care and education is a concern that
must be addressed. Additionally, it is clear that the number
of high-quality programs available is inadequate, regardless
of the availability of enrollment spaces.
Cost of care in Arizona must also be considered when reviewing issues
of access. Some Arizonans may need to spend as much as one-third
of their income on child care for a single child. For young families, working
parents, and especially low income families, the cost of care and education, let
alone high-quality care, is unaffordable.

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Arizona’s Current Early Childhood Development and Health System

In Arizona Today
A few indicators that can help paint a statewide picture of the availability of early care and
education services in Arizona are: 1) current enrollment numbers for various state and
federally funded and licensed programs; 2) data related to the availability of programs.
The number of children a state serves in preschool is considered to be an indicator of
children’s chances for success. Compared with other states, Arizona ranks 48th in the
nation in providing children with preschool experiences.73

In 2005, 33% of all Arizona’s three and four year olds were identified as enrolled in
preschool compared to the national average of 45%.
Preschool settings include state, federal, or privately funded programs such as Title
I Even Start, Early Childhood Block Grant, Head Start or private child care. This
percentage does not necessarily identify the number of children enrolled in, or who
need, full-time care.74

It is difficult to determine how many families do not have access to needed child care.
The available data related to the number of child care spaces is based on centers’ and
homes’ licensed and certified capacities. The counts only reflect the numbers of children
legally allowed, not the actual number that can be served. In an attempt to identify the
actual availability of Arizona’s child care services, population estimates were compared
to the infant and toddler licensed capacities in regulated care settings. Based on the data
below, it appears that Arizona has a significant gap between available care and families’
needs for care.

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First Things First 2007 BUILDING BRIGHT FUTURES

Access

Based on population estimates in 2006, Arizona has capacity to serve 5.92% of
the infant population and 12.41% of the toddler population in the Department of
Health Services licensed child care centers. However, it is believed that a significant
number of infants and toddlers are cared for in unregulated settings such as with
friends or family. The number of children cared for in those settings is not currently
available.75

Arizona families are working, but they are struggling financially. Fifty-nine percent of
Arizona families have an income of less than 200% of the poverty rate ($41,300 or less
for a family of four), which ranks Arizona near the bottom at 41st in the country.76 The
purchasing power of a household income is in decline. Many of Arizona’s families
face significant financial challenges and are presented with difficult choices when
deciding whether they can afford the cost of child care. The average annual
cost of a single preschool child in child care equals $5,832. In comparison,
that cost is $1,156 more than the average cost of tuition and fees at an
Arizona public university.77

The average annual cost of child care in Arizona for a single child
is $7,860 for infants and toddlers and $5,832 for preschool age
children. For infant care, this amounts to as much as 32.5% of the
median family income for a single parent family. For a single preschool child
in care, this amounts to 24% of the median family income for a single parent.78
Having two children in care (one infant, one preschool age child) increases the
average annual cost of care to $13,692, or 57% of the median single parent
annual income.79

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Arizona’s Current Early Childhood Development and Health System

Arizona permits eligible working parents who earn 165% or less of the Federal Poverty
Level ($34,073 for a family of four) to receive a subsidy for a portion of the cost of child
care. Based on a sliding scale, families are required to pay a copayment to the child care
provider. In addition, families may have to make up the difference between the cost of
child care and the subsidy.

The state child care subsidy rate for reimbursement to DES contracted providers is
eight years behind the market cost of service.80

Programs serving eligible families by accepting this rate of reimbursement often operate
based on a budget model that is almost eight years behind the current market rate. The
result is often a lower level of quality because financial resources are not available to
support higher quality services.

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First Things First 2007 BUILDING BRIGHT FUTURES

Access

Arizona’s Assets
Accessibility, availability and affordability of high-quality care are integrally linked for
families with young children. Arizona provides services to children in low income families
through a few state and federally funded programs. These services are only available
to those families deemed eligible based on income, and each program has a different
income scale which determines eligibility.

Programs and Services that Address Availability and Affordability
Asset Item

Agency Responsible

Description

Number of Children
Served (2006)

Child Care Subsidy
Program

Arizona Department of
Economic Security

Child care subsidies
for low income Arizona
families and support to
improve quality of child
care in Arizona.

52,521 children received
subsidies in 2007.

Early Childhood Block
Grant (ECBG) Preschool
Programs

Arizona Department of
Education

Preschool education and
support services provided
to preschool children who
qualify for free or reduced
lunch.

5,339 children were
served in ECBG programs
in 2006. This number
dropped to 5076 in 2007.

Head Start/Early Head
Start

Federal Department
of Health and Human
Services/Office of Head
Start

Comprehensive early
Funded to serve 13,215
childhood education
children statewide.
program for children
pre-birth to five living at or
below the federal poverty
level.

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Arizona’s Current Early Childhood Development and Health System

Early care and education is provided to children of all income levels through a variety of
private for-profit and not-for-profit agencies. Information provided below is limited to those
centers and homes that register with Child Care Resource and Referral. These indicators
do not necessarily include all regulated care environments and could include some
unregulated family home care providers. Additionally, numbers are not unduplicated.

Additional Programs and Services that Provide Service Delivery
Asset Item

Agency Responsible

Description

Capacity to Serve

Private Child Care Centers

Independent not-for-profit
and for-profit agencies,
licensed through DHS,
Office of Child Care
Licensure.

IIndependently owned and
operated early care and
education settings serving
part-day and full-day
care and education needs
of children ages birth
through five years.

Birth to one year: 486
centers;
one year to less than three
years: 776 centers;
three through five years:
1,335 centers.

In home care of children
birth through five years.
May be provided by a
relative.

Birth to one year: 1,948
homes;
one year to less than three
years: 2,196 homes;
three through five years:
2,289.

Child Care Home Providers In-home providers
licensed through DHS or
certified through DES;
or if fewer than four
children served, may be
unregulated.

What’s Missing

40

Gap in Service

What it Means

Severe limitations in available service
capacity data for regulated settings;
no data for unregulated settings.

Demand for early care and education and the current capacity
cannot be accurately determined. Data is not gathered which
would inform the following:
·• how many children/families need services;
·• how many children are receiving services;
·• number of families who cannot access services;
·• actual service capacity of regulated and unregulated
care and education.

C
 urrent subsidy rate is based on
the 75th percentile of Arizona Child
Care Market Rate Survey, for the
year 2000, plus 5%. This sets the
state child care reimbursement rate
eight years behind the market cost
of service.

Program providers who deliver services at this rate of reimbursement are constrained to operate based on a budget model that
is eight years behind; therefore service is driven to a low level of
quality.

First Things First 2007 BUILDING BRIGHT FUTURES

Parents needing this assistance (at or below 165% FPL) for child
care in order to work or attend school are limited to the services
provided at this rate.

Access

Arizona’s Opportunity for Change
Availability and affordability of quality early care and education is a priority in Arizona. Too
few services exist, and those that do are often inaccessible to many families.

1.
2.
3.
4.

Increase the number of and improve quality of infant and toddler service
providers, especially in rural areas.

Address affordability of quality services through increased subsidy rates,
increase access to subsidized programs, and identify other methods to increase
affordability.

Increase public awareness and communication about services that are available
to enhance families’ understanding and use of resources in their communities.

Improve data collection systems to provide a better understanding of the state’s
need for services relative to availability.

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Arizona’s Current Early Childhood Development and Health System

“Does anybody really believe that a kid who’s ill or hungry
can do very well educationally? I don’t think so.”
Dr. Edward Zigler,
NIEER Scientific Advisory Board and Director Emeritis,
Edward Zigler Center in Child Development and Social Policy, Yale University

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Arizona’s Current Early Childhood Development and Health System

Health

What is the status of children’s access to
health in Arizona?

The Arizona Picture
Background
High-quality and accessible health care should be available to all Arizona children and their
families. A child’s healthy development is integrally related to learning, social adjustment,
and safety. Healthy children are ready children; ready to engage in the developmental tasks
of early childhood and to achieve the physical, cognitive, and social-emotional well-being
necessary for success in school and life. Quality early childhood health care systems are
integrated with other care and education supports. Additionally, quality systems have
a broad focus that is inclusive of children’s physical, oral, behavioral, nutritional, and
social health. They go beyond providing insurance coverage and medical care. Instead,
a comprehensive system includes health professionals at many levels of intervention
in the continuous observation and supervision of children’s overall developmental and
health needs.
Good health begins before a child is even conceived. Women who avoid smoking and
other toxins, and who are in otherwise good health, tend to have healthier babies. A
system which promotes children’s healthy development is one that recognizes that
health maintenance is a lifelong process that begins prenatally and follows individuals
throughout their growth and development.
Within an integrated health care system, expectant mothers receive ongoing, regular
prenatal care to support safe, healthy pregnancies. Women who do not receive early and
continuing prenatal care have double the risk of delivering a premature baby.81 They are
three times more likely to deliver a baby with a low birth weight (5.5 pounds or less).82 If
children are born premature or with low birth weight, they face greater challenges as they
grow. Premature and low birth weight children are 50% more likely to be identified as
in need of special education and to be a grade behind their age-appropriate academic
level.83 Early and continuous prenatal care and its relation to prematurity and low birth
weight are of great concern to Arizona communities with 22% of women in 2006 not
receiving prenatal care within the first trimester.84

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Arizona’s Current Early Childhood Development and Health System

Children’s access to ongoing and high-quality preventive, primary, and comprehensive
health services strongly supports their healthy development. Because child health sets
the stage for a healthy adulthood, it is foundational to adult health and well-being. An
indicator of access to ongoing medical care is health insurance coverage. Whether
private or publicly funded, health insurance benefits are a reliable indicator that children
will receive needed medical care. Children without health insurance are less likely to have
access to a primary care physician or a medical home.85 Additionally, parents whose
children are not insured are more than twice as likely to delay taking their children
for any kind of health care visit, including well-child check-ups.86
Another key indicator of high-quality and comprehensive health care
is that it includes developmental and health screenings for the early
identification of possible physical or developmental concerns.
Nearly half of parents nationally have concerns about their young
child’s behavior (48%), speech (45%), or social development
(42%).87 Research indicates that health practitioners such
as pediatricians, family practitioners, nurse practitioners,
and physician’s assistants have a strong influence on
parental thoughts and behaviors. As a point of contact
with the majority of young children and their families, the
health professional has a critical opportunity to engage with
families regarding their children’s health and development.
These professionals can act as a “first responder” for the
early childhood development and health system.
When risks to children’s health and development are identified
early, children have a greater potential for enhanced growth and
development. Health concerns and learning delays are often significantly
reduced when risk factors are addressed during a child’s earliest years.
Children with disabilities who receive early intervention services show significant
development improvement after only one year.88 After receiving services, many infants
and toddlers reach milestones in motor skills, self-help, communication and cognition.
Families also report feeling better able to help their children learn and cope.89

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Health

In Arizona Today
The importance of early and continuous prenatal care for Arizona women cannot be
underestimated. When expectant mothers do not receive prenatal care, they are more
likely to deliver babies prematurely or with low birth weight. Arizona mothers access
prenatal care less often than the national average. This puts more Arizona infants at risk
of low birth weight and premature delivery and therefore more at risk for developmental
and health challenges right from the start of life.

7% of infants born to Arizona women in 2006, who received early prenatal care,
had low birth weight. For women who received no prenatal care, the number of
babies born with low birth weight more than doubles to 15%.90
In 2004, 76% of pregnant women in Arizona received prenatal care in the first
trimester compared to 84% of pregnant women nationally.91
In 2004, 7.5% of pregnant women in Arizona received late or no prenatal caremore than double the national rate of 3.6%.92

There are also significant differences in the utilization of prenatal care by Arizona women
when viewed by race and Hispanic origin. This indicates a strong need for greater
outreach of the importance of prenatal care among these specific groups.

In 2004, 3.1% of White, Non-Hispanic women received late or no prenatal
care, 6.9% of Black, Non-Hispanic women received late or no prenatal
care and 11.1% of Hispanic women received late or no prenatal care.93
American Indians were least likely to enter prenatal care in the first
trimester with only 66% of expectant mothers receiving care in 2006.94

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Arizona’s Current Early Childhood Development and Health System

Insurance coverage is critical when measuring young children’s access to a quality health
care system. Too many Arizona children are without coverage, which in turn means that
too many of Arizona’s children do not receive the consistent and timely medical care they
need. Children in families without health insurance are less likely to be fully immunized,
attend well-child visits, see a dentist, or seek care early during episodes of illness.95
Parents without insurance are more likely to rely on over-the-counter or home remedies
when their children become ill. Not only are too few children in the state insured, but the
problem of children without insurance is growing, not improving.

In 2005, the percent of Arizona’s children ages birth through five without health
insurance rose to 19%, up from 15% in 2003 and 2005. This compares to 11% of
children ages birth to five who are without insurance nationally.96
For Medicaid-eligible children ages 3-6, 56.7% received well-child visits in 2005.
Arizona lags behind the national rate of 62% for Medicaid-eligible children
receiving well-child visits.97
For Medicaid-eligible children from birth to 15-months-old, the rate of children
having 6 or more visits was 57.1% in 2007.98

81% of Arizona children ages 19-35 months have been fully immunized - just below
the national rate of 82% for 2005.99

Another strong indicator of whether or not children have access to care includes the
availability of service providers throughout the state. The federal Health Professional
Shortage Area (HPSA) designation identifies areas or populations as having a shortage of
dental, mental, and primary health care providers. With a shortage of 255 full-time primary
care physicians, Arizona’s needs outbalance the availability of health care providers.100
Regardless of insurance benefits, children in Arizona have limited options for services,
especially if they have special health care or social-emotional needs. Families

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Health

must often travel great distances to obtain services for their child with special health care
needs. There are not enough doctors or therapists in Arizona to serve the vast majority
of communities, and the problem is not necessarily unique to rural areas of the state.

As of June 26, 2007, 55 areas and 33 facilities across most of Arizona have been
designated as Primary Care Health Professional Shortage Areas.101

Accessible health care for young children also includes access to oral health care. A
dental visit by age one promotes healthy development of the teeth and mouth, which in
turn helps prevent later dental disease to permanent teeth or developmental conditions
such as speech delays. Arizona’s children need earlier dental treatments as indicated by
the large percentage of children in preschool and elementary school with tooth decay or
other oral health problems.

Over 66% of 3rd graders in Arizona have cavities and nearly 40% have untreated
tooth decay. Nationally, 58.6% of all 3rd graders have cavities and 28% have
untreated tooth decay. 102
Of the Arizona Head Start preschool children enrolled in 2005-2006,
94% received dental exams. Of the children receiving exams, 46%
of them required further treatment. 103

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Arizona’s Current Early Childhood Development and Health System

Children with special developmental or health delays who do not receive needed care and
support are extremely vulnerable to poor growth outcomes. Early treatment of children’s
special health needs is of utmost importance in preventing possible negative and lasting
effects. Assuring their children receive intervention services early is difficult for Arizona
parents, particularly in rural areas. There are a variety of challenges that families face.
Children in Arizona may not receive the benefit of early screening, may lack insurance
coverage, may lack access to available therapists or other intervention professionals in
their communities, or have a delay not severe enough at the time of screening to qualify
for early intervention services such as the Arizona Early Intervention Program (AzEIP).
Compared with other states in the nation, Arizona has one of the narrowest definitions
of eligibility for early intervention services for children birth to three. This means that
many children must go without intervention until their developmental delays become
much greater. Parents may not have the specialized skills to overcome their children’s
development delays, and the child may not be receiving other services that would assist
in preventing further delays.

In 2005, Arizona served 1.61% of all children ages birth to three through Arizona
Early Intervention Program (IDEA, Part C). If consistent with the national
baseline, Arizona would serve 2.4% of the birth to three population
indicating that approximately 2,200 more children would
be eligible and enrolled in early intervention services.104

5.2% of Arizona children ages three to five years
received intervention services in 2005 (IDEA, Part
B),105 compared with a national average rate of
5.84%.106

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Arizona’s Assets
Arizona has maintained concerted efforts toward the advancement of improved health
services for young children. Several agencies across the state champion this hard work
through collaborations and partnerships to ensure children are healthy and ready for
success.
Two focus areas for understanding Arizona’s assets for access to quality early childhood
health services include early screening and identification along with programs providing
health service delivery.
Several programs throughout the state work to address issues of access to health care.
Some of the key programs on which Arizona can build to ensure children have access to
health professionals and quality health care include the following:

Health Service Delivery
Asset Item

Agency Responsible

Description

Arizona Health Care Cost Containment System (AHCCCS)

AHCCCS

State Medicaid agency for acute
and long-term health care services
through contracted managed care
organizations in Arizona.

KidsCare

AHCCCS

Arizona’s public health insurance
program for children and their
parents with incomes up to 200% of
federal poverty level.

Children’s Behavioral Health
Services

ADHS

Arizona’s publicly funded behavioral
health system for individuals,
families, and communities. ADHS
manages the delivery of services
through 4 Regional Behavioral
Health Authorities (RHBA) and 5
Tribal RHBA’s.

Children’s Rehabilitative Program

ADHS

Coordination, treatment and followup care for children with special
health care needs located in the
Phoenix, Tucson, Flagstaff and Yuma
areas.

Arizona State Immunization Program ADHS

Immunization services provided by
public and private organizations and
practitioners who are enrolled in the
ADHS immunization program.

Arizona WIC Program

ADHS – Office of Women, Infants
and Children (WIC)

Federally funded program
which
continued
provides Arizona residents with
nourishing supplemental foods,
nutrition education, and referrals.

Community Primary Care Program

Various federal, state, and private
funding sources

Health services delivered through
19 public and non-profit entities; 14
First Things
BUILDING
BRIGHT FUTURES
federally First
qualified2007
health
centers (11
in rural Az); 101 clinics in 13 counties; 41 school based clinics.

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Arizona’s Current Early Childhood Development and Health System

Health Service Delivery

50

continued

Asset Item

Agency Responsible

Description

Arizona WIC Program

ADHS – Office of Women, Infants
and Children (WIC)

Federally funded program which
provides Arizona residents with
nourishing supplemental foods,
nutrition education, and referrals.

Community Primary Care Program

Various federal, state, and private
funding sources

Health services delivered through
19 public and non-profit entities;
14 federally qualified health centers
(11 in rural Az); 101 clinics in 13
counties; 41 school based clinics.

Health Start

ADHS – Bureau of Women’s and
Children’s Health

Through the use of lay health
workers, provide education, support,
and advocacy services to pregnant/
postpartum women and their
families in targeted communities
across the state.

Healthy Families

Department of Economic Security

Prenatal and from birth home
visiting program of health and social
services to ensure the health and
wellbeing of children at risk for
abuse and neglect. Families may
participate in this program until their
children are age five.

Health Start

ADHS – Bureau of Women’s and
Children’s Health

Through the use of lay health
workers, provide education, support,
and advocacy services to pregnant/
postpartum women and their
families in targeted communities
across the state.

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Health

Several programs in Arizona address the issues of early screening and identification
of special health or developmental needs. These programs recognize the need for
Arizona families to have access to early intervention services for the positive growth
and development of their young children. Some of the assets for early screening and
identification on which Arizona can build include the following:

Early Screening and Identification
Asset Item

Agency Responsible

Description

Arizona Early Intervention Program
(AzEIP)

AzEIP and Division of
Developmental Disabilities (DDD)
under DES

Statewide system of supports and
services for families of children,
birth to three, with disabilities or
developmental delays.

Parents Evaluation of Developmental Arizona Academy of Pediatrics,
Status (PEDS) Project
AHCCCS, and ADHS

Developmental screening at
well-child visits using the PEDS
screening tool at 9, 18, and 24
months for children enrolled in
the Arizona Health Care Cost
Containment System (AHCCCS).

Newborn Screening Program

ADHS

Program providing contracts with
the State Health Laboratory for
conducting congenital disorder tests
and provide follow up services by
newborn health specialists.

High Risk Perinatal Program

ADHS

Through contracts with NICUs,
provides developmental specialists
who evaluate neonates’
developmental status and assists
in directing appropriate care. Also
provides a community health nurse
to homes for periodic screening of
developmental delays.

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Arizona’s Current Early Childhood Development and Health System

What’s Missing

52

Gap in Service

What it Means

Too few health professionals and
therapists are available throughout
the state.

As Arizona’s population grows, so does its needs for various
health care services. But there are already too few practitioners
available throughout the state to effectively serve the needs
of families. This means that children may not have access to
essential health services, care is delayed, or parents have to
travel great distances to obtain services. This strains the health
care system as well as the families and children who are waiting
for care.

Too many children in Arizona go
without health insurance. Many
families do not have employer
provided health care and cannot
afford private insurance but have
incomes that do not qualify them for
subsidized health care services.

Without health insurance, children are less likely to receive the
ongoing health and oral health care they need to maintain good
health and support development. Children with unmet health
care needs tend to have greater risks for other developmental
problems. These children arrive at school developmentally
unready or with health conditions that impair learning.

Insurance coverage does not
usually cover the costs of early
developmental screening of infants
and young children.

Early developmental screening should be encouraged as a
covered service under both public and private insurance.
With routine early development screening early detection of
developmental delays will be more likely and intervention can
begin in a timely manner to the benefit of children and their
development.

Many eligible children are not
enrolled in Arizona’s Medicaid or
KidsCare programs.

The children not enrolled are less likely to receive preventive
health care, have a usual source of care or a medical home.

Hispanic and Native American
women are less likely than other
Arizona women to receive early or
continuous prenatal care.

F ewer Arizona women than the national average receive early
prenatal care, increasing the likelihood of delivering babies
prematurely or of low birth weight. These fragile infants require
more intensive and costly care at birth as well as the possibility
of health and development problems that require long-term
intervention.

Licensing regulations for Arizona
early care and education settings
do not reflect national standards for
health and safety. Standards such
as requiring infants to be put to sleep
on their backs are not yet required
practices. Additionally, the low
qualifications for care and education
staff do not encourage the hiring of
skilled or trained professionals who
would effectively ensure children’s
health and safety.

Arizona’s minimal health and safety requirements do not support
high-quality out-of-home care settings for young children.
Adopting the national standards for health and safety would
improve the well-being of children throughout the state. Child
care health consultation is a national standard that has been
shown to improve the health and safety of children in child care
settings.

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Health

Arizona’s Opportunity for Change
Arizona is fortunate to have many quality assets to support the healthy growth and
development of babies and young children. However, thousands of eligible, low-income
children are not enrolled in Arizona’s public health program (KidsCare) that would afford
them access to comprehensive health care services. Those that do have public or private
insurance coverage often find the health care system difficult to navigate or simply too far
away to be easily accessible. Community and professional information sources identify
the following strategies be considered to increase access and coordination of health and
development resources.

1.
2.

Engage in information and outreach campaigns to enroll all eligible children in
KidsCare or Medicaid programs.

Increase the number of pediatricians and other medical doctors that perform
early developmental screenings in accordance with recommendations of the
American Academy of Pediatrics.

3.

Increase the availability of oral health screenings and treatment, especially in the

4.

Implement a child care health consultant system to support health and safety of

5.

Coordinate and enhance early childhood health resources within state agencies

6.

rural communities.

children and staff in early care and education settings.

and community-based delivery systems.

Enhance outreach and services to women to improve the number of mothers
who receive early and continuous prenatal care.

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Arizona’s Current Early Childhood Development and Health System

“The health and welfare of children depend on the ability
of families and their community support systems to
foster positive emotional and physical development.
Recent scientific research confirms that brain growth and
neurophysiologic development during the first years of
life respond directly to the influence of early emotional
relationships.”
American Academy of Pediatrics
Committee on Early Childhood, Adoption, and Dependent Care

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Arizona’s Current Early Childhood Development and Health System

Family
Support

What is the status of family support and early
literacy in Arizona?

The Arizona Picture
Background
No program or service can substitute for the sense of identity and attachment children
establish through ongoing love and care they receive in their home. A system that
establishes successful quality and accessibility strategies will only partially address young
children’s needs. An effective early childhood and development system also recognizes
the importance of family as a child’s first and foremost caregiver and teacher. Assuring that
family supports and services are included in any system serving young children is critical.
A strong system addresses the needs of all families, but in particular those that are most
vulnerable due to economic, educational, or language barriers. Full success is only
achieved when an early childhood development and health system works to strengthen
families, reduce children’s risk factors, and provide significant opportunities for families
to play the strongest role possible in their children’s development.
Families in Arizona should have confidence they live in a state where their needs are
supported, where they can access information easily, and where they know their young
children will grow healthy and ready for school and success. Children’s families contribute
the most influence over their health, development and safety, and when families are under
strain, children are the most vulnerable. Children who live in family settings filled with stress
and instability due to financial or other burdens, can have delayed or poor growth and
development. But when young children receive stable and supportive parenting during
their youngest years, the stage is set for a child to achieve success throughout life.
Societal and cultural changes have profoundly impacted family structures and patterns
over the past fifty years. Children are spending longer hours in out-of-home care settings
as increased numbers of parents, mothers in particular, participate in the workforce. Sixty
five percent of all mothers with preschool-aged children are in the labor force, reflecting a
twofold increase since 1970.107 In addition, increases in residential mobility have created
a lack of extended family and close-knit community supports. It seems almost instinctive
then, that strengthening families includes activities in which families can grow through
mutual support and self-help.

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Arizona’s Current Early Childhood Development and Health System

In Arizona Today
Arizona parents and communities recognize the vital role families play in assuring
their children’s success. In a survey prepared for Valley of the Sun United
Way in 2005, respondents overwhelmingly cited family as having the major
responsibility for children’s positive school outcomes. Placing second in
respondents’ views were teachers and schools. Society/community,
government, and religion all shared some responsibility for children’s
success as well. At the same time, the majority of respondents did not
believe that Arizona children were well prepared to enter kindergarten.

97%

of respondents answered family when asked who
has the major responsibility for kids being successful in
school.108

45%

of respondents added that teachers and schools also share
responsibility for children’s success in school after family.109

57% of respondents who had an opinion answered “not very well prepared” when
asked how prepared kids are to enter kindergarten.110

Arizonans believe that there is more the state can do to support children’s growth and
development. In particular, access to programs for improving parenting was seen as a
major change that was needed to better support children and their families.

19% of respondents answered parenting when asked what changes are needed in
the way we support our children. The answer was second only to education which
was cited by 36% of respondents.111

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Family Support

A key message for assisting parents in the support of their child’s development and
school preparedness is promoting daily reading activities in the home. Strong language
and literacy development plays a crucial role in children’s school success. To understand
how well parents are internalizing early literacy messages, children’s literacy development
and family reading patterns are reviewed. These patterns indicate that Arizona needs
to improve how well the state informs and supports families in applying information
regarding children’s reading activities. Compared to the national average, significantly
fewer Arizona parents read to their children on a daily basis.

43.2% of Arizona children ages birth through five are read
to daily, which ranks Arizona 44th in the nation for
the percentage of children birth through five
being read to each day.112

Why are Arizona families reading to their
children less often than other families across
the country?

Are Arizona families less

aware of early literacy importance? Or,
are fewer Arizona families able to provide
support for their children due to their own
educational or situational factors such as
poverty, illiteracy, or language barriers?
Addressing the concern is twofold. First,
awareness activities should increase to
ensure the information continues to be
presented to families with young children.
Second, communities can work to support
parents’

own

educational

attainment

and

language acquisition through adult literacy and
English classes. However, finding such support systems
is becoming increasingly difficult in Arizona. Fewer adult
education and family literacy classes are available as funding
continues to be reduced to programs across the state.

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Arizona’s Current Early Childhood Development and Health System

Funding to the Arizona Family Literacy Programs has been reduced by 72% since
2004. Due to these severe cuts in funding, State Family Literacy programs have
gone from being able to serve more than 1100 families to serving less than 300
families. 80% of families served by these programs have annual incomes that
meet Federal Poverty Levels and are those families most
in need of support services.113

Arizona’s Assets
The system of family support and the
provision of information for families
currently in place include state, federal,
and

privately

funded

programs

specifically designed to strengthen
families and support parent and
family skill building. A variety of
agencies collaborate in both public
and private partnerships to offer
services focusing on family support
and education and early literacy.
Family

support

and

education

programs work with families to inform
and educate. These Arizona programs
focus on increasing awareness of children’s
development as well as connecting families to
needed support systems. Several programs are in
place that can be enhanced for better family support
development.

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Family Support

Family Support and Education
Asset Item

Agency Responsible

Description

Promoting Safe and Stable Families

DES

Program to stabilize families through
family-centered, comprehensive,
coordinated and community-based
services.

Healthy Families

DES

Program to enhance parent/child
interaction, promote child health and
development, prevent child abuse
& neglect, and strengthen family
relations.

Grandparent Kinship Care

DES

Financial support for grandparents
who are caring for their
grandchildren.

Child Care Resource and Referral
Programs

Association for Supportive
Child Care and Child and Family
Resources

Information and support to families
seeking child care services.

The Emily Center at Phoenix
Children’s Hospital

Phoenix Children’s Hospital

Pediatric information and resource
center (with a link to public libraries)
with free, accurate, and easy to
understand information on children’s
health and safety.

Birth to Five/Fussy Baby Help-line

Southwest Human Development

A statewide parent help-line that
provides a trained professional
to respond to the concerns and
question of parents with children
birth to age five.

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Arizona’s Current Early Childhood Development and Health System

Early literacy programs vary in service delivery activities. The main goal of all of Arizona’s
current early literacy assets is the same. Each of the programs currently in place works
toward improving children’s literacy development. Some of the programs focus on
building parents’ skills while others focus on children’s literacy. All of the listed programs
seek to assure children gain important skills that support their success in school and life
through language and literacy development.

Early Literacy
Asset Item

Agency Responsible

Description

Arizona Family Literacy Programs

ADE

Program providing support for
the whole family through adult
education classes, early childhood
education and education on
supporting children’s literacy
development .

Community Libraries

Tribal and Local Governments

159 public libraries located in
every county and on several tribal
reservations and serve as partners
in parent education and providers of
literacy programs children and their
parents.

Reach Out and Read

Reach Out and Read Arizona

A pediatric early literacy program
that makes literacy promotion a
standard part of pediatric primary
care.

What’s Missing

60

Gap in Service

What it Means

Too few programs are in place to meet the
demand and need for addressing families with
educational or literacy needs.

Families who are most vulnerable to unstable
situations cannot access needed supports and
services. In turn, children may miss out on being in an
environment that best promotes their healthy growth
and development. Programs and services need to
be able to respond to the multiple language needs
of families and the diverse cultures represented in
Arizona’s population.

There are not enough programs that provide
classes in parenting, using positive discipline,
prenatal care, or benefits of parental
involvement.

Parent and family support are keys to improving
quality in early childhood services. When parents
who desire and seek services cannot access the
information they feel they need, children may not
receive the benefits of strengthened family situations.

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Family Support

Arizona’s Opportunity for Change
Arizona’s families need supports and services that are accessible and in formats easily
understood. Programs and services need to build upon parents’ current skills, knowledge,
and strengths to optimize good developmental outcomes for children. Strengthening
family supports and services to improve children’s development and early literacy would
lead to positive outcomes for all of Arizona. Arizona’s opportunities could be outlined as
follows:
Provide parents with opportunities to improve their own literacy skills and

1.

knowledge of how best to support their children’s literacy development. For
families with low income, low education level, or language barriers, provide the
knowledge and skills to promote their own reading, reading with their children,
and having access to books.

Increase availability of, and access to, information regarding parenting, child

2.

development, where and how to seek assistance, and what to look for in quality
services and supports. Be responsive to Arizona’s diverse families through the
use of multiple delivery methods and venues, such as public libraries, and in
languages most used by families in those communities.

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Arizona’s Current Early Childhood Development and Health System

“We have to dream about new ways of preparing high-quality
early childhood educators. It is time that policy makers,
researchers, educators, and society as a whole address indepth the funding, policy and implementation issues related
to early childhood professional development. We have to
create a seamless system of both high-quality early childhood
education and high-quality early childhood professional
development programs. We must groom a new generation of
leaders in a thoughtful and well-planned way.”
Naomi Karp,
Building a New Early Childhood Professional Development System
Based on the 3 Rs: Rigor, Research, and Respect, 2007

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Arizona’s Current Early Childhood Development and Health System

Professional
Development

What is the status of early
childhood professional
development in Arizona?

The Arizona Picture
Background
The best predictor of overall quality in early childhood education and care programs is
the skill, experience and educational level of their teachers. Yet in Arizona, many early
education teachers do not have the training or educational preparation necessary to
effectively address school readiness, let alone the rising number of other developmental
and health issues presented by young children. Children in early care and education
settings often receive instruction from teachers who meet only the minimum, statemandated requirements for child care licensure; the teacher be at least 18 years old, have
a high school diploma or its equivalent, and have six months of child care experience.
Additionally, providers’ access to early childhood teacher certification is limited with
only four university teacher preparation programs currently approved by the Arizona
Department of Education. Wide variations in teaching requirements for different settings,
professional development, and teacher preparation produce large disparities in practical
competence, program quality, and positive outcomes for children.
Further complicating the system of cohesive and coordinated professional development
is the broad range of service providers, from grandparent caregivers to center-based
classroom teachers, who have young children in their care and are in need of education
and training. Traditional education systems are often ineffective in reaching this sector of
the early childhood workforce in terms of both the types of information provided and the
formats in which they are made available. The non-degree seeking providers, such as
family members or neighbors, need access to professional development opportunities
which address their unique training and educational needs.

In Arizona Today
Early care and education settings in Arizona vary in the requirements they must meet
regarding qualifications of the teachers present. In early childhood education classrooms
administered through the Arizona Department of Education (i.e., Early Childhood Block
Grant, Early Childhood Special Education, Title I Even Start or Family Literacy, or Title I
funded preschools), teachers must hold an early childhood teaching certificate (mandated
as of July 1, 2009). Teachers not located in these settings, where most children are

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Arizona’s Current Early Childhood Development and Health System

served, need only meet the minimum requirements as set by the Department
of Health Services, Office of Child Care Licensure. Minimal educational and
experience requirements allow children to be cared for in settings where
adults are unskilled and untrained. Without a highly skilled teacher,
a child’s learning opportunities are minimized and potentially
hindered.
The vast majority of teachers (68%) working with Arizona’s
youngest child population do not hold a college degree. In
fact, almost one-third of early education teachers hold only
a high school diploma or less.114 Additionally, those teachers
who do report having a four-year degree may not necessarily
be educated in an early childhood education or related field. The
reported degree could be in accounting, but the way in which
data is currently collected does not account for the identification
of specifically trained teachers working with young children. Overall,
Arizona’s early childhood workforce is under-educated and untrained
which lessens the quality of the experiences children receive.

32% of the early childhood teachers in Arizona hold some type of four-year college
degree. An almost equal number of early childhood teachers, 31%, have attained a
high school diploma or less.115

Other personnel who work in the early care and education profession are also entering
the field with little educational background and experience. Most assistant teachers,
who often have similar responsibilities as the classroom teacher, have only a high school
diploma or less. Even program directors, those in the highest responsible positions,
typically have less than a four-year college education. Directors are responsible for
training and supervising teachers, but they themselves often do not have the educational
background or knowledge to best support teachers’ learning of high-quality instruction
and care.

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Professional Development

56% of assistant teachers in early care and education settings have only a high
school diploma or less with only 8% of assistant teachers attaining four-year college
degrees.116

58% of program directors who do not have classroom responsibilities hold a fouryear college degree and 34% have some college or an AA degree.117

As expected from the level of educational requirements, teacher wages in Arizona early
care and education programs are lower than other educational professions. Individuals
choosing early care and education as a career will find themselves earning a wage that
places them at poverty level for a family of four. With low teacher wages, programs are
challenged with recruiting and retaining highly qualified staff. As teachers enter and leave
children’s lives, relationships that promote strong bonds between adults and children are
difficult to establish. This in turn diminishes the quality of care accessible to children in
settings where adults do not maintain continuous employment.

In 2006, Arizona early childhood teachers earned an average wage of $9.89
per hour. Nationally, early childhood teachers earn an average wage of $10.91
per hour. This figure includes any individual who instructs children up to five years
of age in activities designed to promote children’s comprehensive development,
including Head Start teachers who typically make $5.00 more per hour than the
average (and who have higher qualification requirements).118
In 2004, 33% of early childhood teachers remained employed for two years or less.
Over half, 55% of assistant teachers remained employed for two years or less.119

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Arizona’s Current Early Childhood Development and Health System

Arizona’s Assets
The providers of early care and education experiences for young children are presented
with a variety of educational and training opportunities. Several agencies and institutions
throughout the state work to provide pathways to ongoing professional development
for those in the early care and education profession. Some key examples of the learning
options available are as follows:

Educational Pathways

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Asset Item

Agency Responsible

Description

Universities and Private Colleges of
Education

State and Private Universities and
Colleges

Four-year degree programs in
early childhood education/teacher
certification and family studies
programs are offered through both
the state and private universities.

Community College Early Childhood
Education

Community College System

Two-year degree programs in
early childhood education, child
development, and child and family
studies.

Professional Career Pathways
Program (PCPP)

Central Arizona College

Program offered at community
colleges throughout Arizona (via
a DES contract with CAC) and
provides scholarships and the
development of a professional
career pathway for individuals
employed as child care providers in
center-based programs, family child
care provider homes or family group
homes.

Statewide Child Care and Early
Education Development System
(S*CCEEDS)

Association for Supportive Child
Care and Child and Family
Resources, Inc. (through DES)

A career development registry
for child care and early education
professionals. Designed to assist
child care and early education
practitioners in tracking their
education and training.

Head Start Teacher Scholarship
Program

Arizona State University in
cooperation with ADE

Grant to fund bilingual Head Start
teachers’ pursuits of their BA in
early childhood education.

Chase Early Education Emergent
Leaders Program

Governor’s Office of Children, Youth
and Families/Division for School
Readiness

A one year intensive program of
early childhood management and
leadership skills development
designed to intentionally build
leadership that reflects the cultural
diversity of the children in Arizona.
Cornerstones of the program include
1:1 professional mentoring, a
personal professional development
plan, and completion of a project.

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Professional Development

Arizona provides a variety of opportunities for those involved in the early childhood
education profession to receive ongoing training and technical assistance. These are
projects and programs on which Arizona can build to create a professional development
system that promotes the use of best practices. Valuable learning models can be
reviewed to build high-quality early care and education settings through improved staff
knowledge and skill.

Training and Technical Assistance Systems
Asset Item

Agency Responsible

Description

Arizona Kith and Kin Project

Association for Supportive Child
Care

Training and support to improve the
quality of care provided by family
members and friends who are likely
to be unregulated and untrained.

Project “Me Too!”

Blake Foundation through DES

Contracted service to provide
training to child care centers for
improved teacher quality.

Mind Matters Training Institute

University of Arizona Cooperative
Extension

Free 21 hour training on early brain
development available to all child
care providers throughout Arizona.
Preference is given to those working
in programs that serve children from
birth to age three.

Child Care Professional Training
(CCPT)

Grant funded through DES/Child
Care Administration

Free, two-week (60 hours) course
designed to prepare individuals for
employment in the child care and
early education profession.

Harris Institute

Southwest Human Development

State-of-the-art training programs
at three levels (a two year infant/
family clinical practice certificate,
a one year infant/family studies
certificate, and seminars and short
courses). The Institute also has an
infant mental health clinic and a
consultation program.

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Arizona’s Current Early Childhood Development and Health System

What’s Missing

68

Gap in Service

What it Means

There is a lack of competencybased standards within licensing
regulations for education/training of
early care and education personnel.

The majority of teachers working with young children have little
education or experience working in the profession. Children are in
settings where those who are responsible for their health, safety,
well-being, and learning do not have the skills or knowledge
necessary to provide high-quality care and learning experiences.

Community college courses and
those at four-year universities
do not completely, nor smoothly,
articulate so that too few pathways
to certification or degree attainment
exist.

Seeking degree attainment is difficult for those who choose to
enter the early care and education field, especially for working
and non-traditional students who need flexible and innovative
educational programs. With upcoming early childhood certificate
requirements and education systems that do not connect, Arizona
could face a shortage of qualified professionals for the early care
and education field.

Arizona lacks a coordinated system
for professional development
with no single point to which an
individual can go for information.

Information for teachers and other professionals is disconnected or
not available due to the lack of coordination.

Limited resources are available
to assist with wage increases
including, lower than market rate
DES subsidies, incentives to hire
and retain highly qualified staff,
and areas where child care costs
are at the limit of what the market
can bear.

Without increased funding or incentives to providers to pay higher
wages, teachers will continue to be paid poverty-level salaries and
leave the field to pursue other work options.

There is a lack of programs
or systems in place that can
effectively address the training and
learning needs necessary to meet
the growing diversity of providers,
their prior levels of knowledge and
their educational goals.

A wide variety of service providers care for children in diverse
settings. The learning needs of grandparents caring for their
grandchildren differ from the learning needs of a classroom
teacher who may work with a child with challenging behaviors.
Obtaining training in rural communities presents additional
challenges. Innovative and flexible learning systems are required to
meet the dynamic and diverse needs of providers.

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Professional Development

Arizona’s Opportunity for Change
Although many opportunities exist for training and professional development, challenges
in reaching the broad range of service providers create a disconnect between the types
of services available and those who can and wish to access them. Along with limited
availability, programs offer limited flexibility in the delivery of information. Low wages
further complicate the ability to recruit and retain highly trained and knowledgeable
staff.
Many public and private entities offer professional development opportunities throughout
Arizona. However, the system lacks coordination and integration as identified by too
few paths to certification and varying requirements for instructional staff. To achieve a
professional development system that paves the way for a more knowledgeable and
highly skilled workforce, the elements of quality professional development and education
must be in place. Possible directions for change are as follows:

1.

Providing adequate funding, sufficient opportunities, and flexible, innovative
delivery models for continuing education and training would enhance early care
and education quality resulting in better children’s outcomes.

In addition to training for people currently working in the field, the workforce

2.

needs to grow. Institutions of higher education need to formalize the articulation
process between community colleges and public universities to allow for multiple
paths to educational attainment and meet the demands of a diverse student
population.

3.

Teachers in the early care and education field need wages and benefits that
provide them with a livable wage and demonstrate the value of the work they
do. Improved wages and benefits provide for stronger retention of a highly
qualified workforce and offer long-term benefits to children and the community
as a whole.

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Arizona’s Current Early Childhood Development and Health System

“Success in building a comprehensive system of services
for young children requires a historical shift in public
perceptions and public will.”
Dean Clifford, Ph.D.
Practical Considerations and Strategies in Building
Public Will to Support Early Childhood Services

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Arizona’s Current Early Childhood Development and Health System

Public Information
and Awareness

What is the status
of early childhood
awareness in Arizona?

The Arizona Picture
Background
The passage of Proposition 203, First Things First, in November 2006 demonstrated
public will to address and elevate the early childhood issue in Arizona, but it was only
the beginning. First Things First emphasized what so many already knew – the first five
years matter most, and every Arizona child must be given the opportunity to succeed
in school and life. Reaching out to those who touch the lives of our youngest citizens
involves providing accessible, high-quality, easy to understand information and resources
that affect outcomes and improve lives.
Only recently have the first years of life become a public interest. Previously considered
a private, family matter, the care and nurturing of young children has been brought to
the forefront due to several recent developments.120 Brain development research in
particular has raised the awareness of the lasting impact children’s environments have
on their development. Additionally, the public is becoming increasingly knowledgeable
about the economic return on investment of ensuring children’s earliest years prepare
them for success in school and life. Guiding this shift in public perception through effective
and multifaceted communications efforts is critically important in garnering the support
necessary for a strong early childhood development and health system.
In order to develop effective communications strategies, it is critical to first obtain baseline
data with which to measure current levels of public awareness. This section provides a
glimpse into what systems and efforts are currently in place in Arizona regarding public
awareness, and examines the current level of understanding about early childhood issues
across the state. This section also identifies critical communications needs that must be
addressed.
There are many indicators which help to paint a picture of the current levels of public
information and awareness about health and development programs for Arizona’s
youngest children. But the lack of a single method for data collection makes precise
measures of families’ awareness about these issues difficult to ascertain. A clearer
understanding of what families already know and wish to know about early childhood

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Arizona’s Current Early Childhood Development and Health System

development and health could better indicate the demand and need for information on
this topic. Additionally, comparing Arizona and national perspectives on topics related to
young children provides another indication of the type of information communities may
need to best support their youngest residents and their families.

In Arizona Today
In a study conducted by the Valley of the Sun United Way, Arizonans were surveyed on
their perceptions of the quality of life for the state’s children. Although an overwhelming
majority of respondents believed that the general public has “some awareness” of the
importance of early childhood development and health, few of those surveyed noted
improving the lives of young children and their families as a major concern. However, the
passage of First Things First by majority vote demonstrates that Arizonans clearly are
concerned for the well-being of young children in Arizona. Arizonan’s are both concerned
about young children’s issues and in need of greater amounts of information. When
asked “how well informed are you about children’s issues in Arizona,” more than one in
three respondents say they are not informed.121

79% of respondents believe that the general public has only some awareness of
the importance of early childhood development and health, and 14% indicated that
the general public has little or no awareness of early childhood development and
health. Only 7% felt that awareness was “a lot.”122

When asked open-ended questions (without being given options), only 1% of those
interviewed mentioned improving the life of children and families as a major
concern.123
The First Things First initiative passed with 53% of the vote, considered to be
a statistical landslide and a clear indicator of public will for early childhood
development and health in Arizona.124

31% of survey respondents say they are “not very well informed” about children’s
issues in Arizona, and 5% stated that they are “not at all informed”.125

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Public Information and Awareness

Although Arizonans do not necessarily feel they are informed about specific issues related
to Arizona’s children, a national survey conducted by the Zero to Three organization can
provide useful information about families general knowledge related to child development.
Based on survey results, parents of young children do recognize the importance of a
child’s early years of development.126

In a survey conducted by the Zero to Three organization (polling 3,000
adults and including over 1,000 parents of children ages birth to six),
85% of parents and 77% of adults reported understanding that a child’s
capabilities are not completely predetermined at birth.127

71%

of those surveyed understand that brain development can be
affected very early on and more than three fourths of adults and parents
believe a child’s experiences in the first year of life have a major impact
on their performance in school many years later.128

97.3% of all parents surveyed believe it is
either “probably true” or “definitely
true” that there is a relationship
between emotional closeness
and children’s intellectual
development.129

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Arizona’s Current Early Childhood Development and Health System

Arizona’s Public Information and Awareness Assets
Although this report does not measure exactly how many organizations are actively
involved in, or how much funding is being allocated for public engagement efforts, it
does highlight some agencies already engaged in various forms of communications
programs.
Some key examples of agencies, services and providers currently addressing issues of
public information and awareness are as follows.

Awareness Efforts

74

Asset Item

Agency Responsible

Description

“Ready to Learn” Brain
Development Campaign

Mesa United Way

Partners with businesses, state and
local governments, schools and
other service organizations to bring
information about the importance of
early brain development.

Protecting Arizona’s Family Coalition Voluntary Association of Member
(PAFCO)
Organizations

Provides advocacy training for
all health and human service
organizations.

Arizona Parent Kits

Virginia G Piper Charitable Trust
Foundation

Free literature and videos distributed
to new parents, designed to
educate young parents about the
developmental needs of young
children.

You’re It! Public Awareness and
Engagement Campaign

Partners for Arizona’s Children and
United Ways of Arizona

Statewide campaign to increase
awareness and engagement around
importance of investing in young
children.

Early Brain Development Information The New Directions Institute for
and Education Efforts
Infant Development

Provides fact-based, high-quality,
accessible training on early brain
development.

Arizona 2-1-1 Online

Information system which describes
thousands of child care, health
care, counseling, and other health
and human service programs and
resources.

AHCCCS

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Public Information and Awareness

What’s Missing
Gap in Service
P rior or current awareness efforts have
had limited use of various communication
methods.

Communications are not necessarily
provided in formats that are accessible
or easy to understand by the variety of
individuals who need the information.

What it Means

Multiple methods have not been used effectively to
increase awareness of children’s issues. Current
systems are missing significant portions of the
population as indicated by the proportion of Arizonans
reporting they were not well informed.
Cultural and language barriers often inhibit families’
access to information. Additionally, communication may
be located in places other than where it is needed, and
families do not know where to go to find the information.

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Arizona’s Current Early Childhood Development and Health System

Arizona’s Opportunity for Change
While there are many organizations who value young children and are engaged in public
information efforts, research of the available data sources shows that many families
continue to lack the information and knowledge they need to feel supported and
informed. Through community forums and interviews, parents, business leaders, elected
officials, educators, childcare providers and countless others emphasized the need for
coordination between the many organizations who serve young children, and asked for
more information that is accurate, accessible, and in easy to understand formats.
Consistently identified was the need for a statewide, comprehensive communications
program that will provide effective information to the audiences who need it. Targeted
messages, to groups that have specific connections to early childhood in particular,
are needed to create a continuous flow of information that is current, consistent, and
relevant.
Strategies and tactics which could enhance awareness in Arizona might include the
following:

1.

Partner with, utilize, and build upon existing resources and networks to reach people
with information through collaborative activities such as working with schools, local/
neighborhood services, community fairs, health care agencies, and others.

2.

Recognize the value and benefits of a variety of media outlets to reach diverse,

3.

Create awareness campaigns that are inclusive of the wide range of development

target audiences such as business leaders, educators, parents, retirees and
others.

and health issues facing young children, from recognizing early signs of
developmental delays, to the importance of early literacy, and locating existing
services and supports.

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Public Information and Awareness

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Arizona’s Current Early Childhood Development and Health System

“Responsibility for school readiness lies not with children,
but with the adults who care for them and the systems that
support them.”
The National Governors Association,
Final Report of the NGA Task Force on School Readiness,
Building the Foundation for Bright Futures, 2005

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Arizona’s Current Early Childhood Development and Health System

System
Coordination

What is the status of program and
service coordination in Arizona?

The Arizona Picture
Arizona’s early childhood development and health system must promote and establish
a seamless system of care. Families must have access to a coordinated network of
services that meet the multiple and changing needs of children. Organizations and
individuals must work together to establish such a coordinated service network. This
requires state and regional coordination of both public and private human resources,
services, and funding.
The coordination of services and programs in Arizona is present in multiple locations
and encompasses a broad range of services and partners. There is recognition that
coordination is an area which must be further explored, and future reports will identify
indicators to assist in measuring the effectiveness and quality of such coordination efforts.
Areas to consider include the building of public will through collective efforts, the quality
of outreach strategies in typically underserved communities, how funding is leveraged
among agencies, and improved capacity in early care and health identification services.

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Arizona’s Current Early Childhood Development and Health System

Arizona’s Assets
Arizona has a foundation of collaborative partnerships. Some have been formed due to
federal program requirements or with the awarding of federal grants, while others have
evolved because of leadership to address a service need or gap, expand a service,
remove barriers and/or strengthen a program or set of programs. Some key examples
of agencies, services and providers currently addressing issues of coordination and
collaboration are as follows:

State – Level Coordination

80

Asset Item

Agency Responsible

Description

Governor’s Children’s Cabinet

Office of the Governor

Cabinet formed by Governor
Napolitano comprised of state
agencies and offices responsible
for services to children & families.
Provides a focal point for policy
development, coordination, and
implementation among state
delivery systems.

State Early Childhood
Comprehensive Systems

Early Childhood Development and
Health Board, Federal Health and
Human Services, Health Resources
and Services Agency

Planning, development, and
implementation of collaborations
and partnerships that support
families and communities in their
development of children who are
healthy and able to succeed upon
school entry.

Child Health Consultation

ADHS, Early Childhood
Comprehensive Systems, Pima
County Health Department

Consultants to child care providers
for the provision of expert
information and assistance in
achieving high standards related
to health of children and safety in
childcare settings.

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System Coordination

Program – level Coordination
Asset Item

Agency Responsible

Description

Coordinated Care Efforts

Head Start, child care programs,
local school systems

Head Start, school systems,
and child care providers are
working together to link programs
together to provide a full range of
inclusive early care and education
experiences for children.

Early Childhood Transitions

Various state and local agencies
such as Head Start/Early Head Start,
Arizona Early Intervention Programs,
and local school systems

Multiple partnerships, collaborations
and agencies working together to
ensure children and their families
have successful transitions at the
various developmental milestones
of young children (e.g. early
intervention to preschool, preschool
to kindergarten).

Public-Private Coordination
Asset Item

Agency Responsible

Description

Arizona Early Education Funds
Regional Partnerships

Arizona Early Education Funds
through the Arizona Community
Foundation

Regional partnerships established
to help communities statewide build
quality and capacity of early care
and education programs for children
birth to kindergarten. Intended to
focus on the provision of services
at the local level and involve
diverse representation within each
community.

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Arizona’s Current Early Childhood Development and Health System

What’s Missing
Gap in Service

What it Means

Many agencies and programs provide early
childhood development and health services in
isolation and without strong systems in place.

Without coordination of services, families do not know
where to enter into a system resulting in duplication
of services and a lack of consistency among service
providers and information.

Arizona’s Opportunity for Change
While there is strong recognition of the many programs and service providers who have
come together in their efforts to serve young children, a need exists for even greater
coordination and collaboration among public and private agencies. Coordination should
assure that duplication of service provision is avoided, communities can build on and
enhance currently existing, high-quality services, and dollars are effectively leveraged for
the highest return on the state’s early childhood investment.

82

1.

Increased coordination across state agencies would improve access to and

2.

Increased collaboration would leverage public and private funding to create a

3.

Strong coordination of services requires accurate and effective collection of

delivery of services for children and families and provide a seamless system of
delivery with strong continuity across providers.

sustainable system which will improve quality, increase access, and provide for
the highest return on investment in early care and education.

meaningful data. A database where indicators of well-being and outcome
measures could be monitored would encourage ongoing and timely continuous
improvements to the system structures and services.

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System Coordination

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83

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Arizona’s
Opportunity
With the passage of the First Things First
initiative, Arizona has secured a valuable
opportunity to create a new vision of early
childhood throughout the state. This report
demonstrates

that Arizona

has

many

assets for serving young children and their
families, but still falls short of ensuring all
of its young children are healthy and ready
to succeed. Building Bright Futures provides
the Board with a first look at Arizona’s
children. Through the thoughtful review
of the information presented, sound policy
decisions can be made as First Things First
moves forward in outlining its strategic plan
for creating a statewide, coordinated early
childhood system.

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85

Arizona’s Opportunity

“Fellow citizens, why do you turn and scrape every stone to
gather wealth, and take so little care of your children, to
whom one day you must relinquish it all?”
Socrates

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Arizona’s Opportunity

The Right System for Bright Futures
The establishment of First Things First poises Arizona to build on the foundation that
exists and continue engaging the multiple stakeholders and leaders to advance this
important effort.

What Arizonans know:

1.
2.
3.
4.

Multiple agencies invest significant federal, state, and private dollars in young
children’s programs and services.

Arizona communities believe in the value of current services available.

Arizona is beginning to collect evidence of the positive outcomes produced by
some of its early childhood development and health programs.

Arizona does not offer all parents nearly enough choices to ensure every child
has an opportunity to achieve his or her potential.

Next Steps
Creating a true, comprehensive early childhood system consisting of organized,
interrelated networks of programs and services requires addressing issues of both
content and infrastructure. The state must be a system of systems in which rigorous
monitoring and assessment ensure positive, expected outcomes occur.
This report is the beginning. While future needs and assets assessments will include
information on improvements made toward First Things First goals and specific strategies
for attaining improvements, this first report provides the baseline. Once specific measures
are determined through strategic planning, subsequent documents will analyze the data
and report on progress. From there, guidance can be provided to state leadership and
First Things First’s partner agencies to further enhance the early childhood development
and health system.

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Arizona’s Opportunity

Building Bright Futures provides First Things First, along with its Regional Partnership
Councils, with initial data on Arizona’s current indicators, assets, and opportunities for
change. The intent of this report is to serve as a resource which, when coupled with
recommendations from the board’s community workgroups, allows informed decisions
to be made about directions and priorities for systems change.
The task of First Things First is to create a sustainable system by choosing wisely among
politically and economically-viable options for a maximum return on its investments.
Creating such a system is no small task, but the result will produce outcomes from which
all of Arizona will benefit – children who are healthy and ready for success in school and
life. The children of Arizona are its strongest asset. The time is now to build the right
system for bright futures

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Arizona’s Opportunity

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Appendix

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91

Appendix

“All the data point in the same direction – early education
matters.”
David L. Kirp
The Sandbox Investment, 2007

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Appendix

Development of the Needs and
Assets Assessment Report
The Statewide Needs and Assets Assessment illustrates a picture of Arizona’s young
children and their families, outlines the early childhood development and health system,
specifically the assets and gaps within the system as it exists today, and provides
suggested future directions. This Statewide Needs and Assets Assessment is the first step
in defining and implementing a comprehensive system of early childhood development
and health. By identifying and attending to the needs and gaps in services that affect
young children’s healthy development and growth, as well as efficiently using limited
funds, a coordinated, sustainable and effective system can be devised that achieves the
desired goals of healthy children who are ready to succeed.
The information included in the Statewide Needs and Assets Assessment was obtained
through the following processes:
1. Background Information – A literature search provided the historical perspective and
current research related to early childhood systems and outcomes.
2. Secondary Data Search – statistical data from the following:
• U.S. Census
• U.S. Departments of Health and Human Services, Labor, and Education
• Arizona Departments of Health Services, Education, Economic Security, Health
Care Cost Containment System
• Governor’s Office for Children, Youth and Families
• Head Start State Collaboration Office
• Arizona Head Start community assessments
• National organizations – Annie E. Casey Foundation, National Association for the
Education of Young Children, and the Center for the Child Care Workforce.

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Appendix

3. Primary Data Gathering – Community input from individuals across Arizona from the
following:
• Seventeen Community Forums held across the state.
• Tribal meetings held with representatives from the Intertribal Council of Arizona, the
Hopi Tribe, the Tohono O’odham Nation, the Pascua Yaqui Tribe, Fort McDowell
Yavapai Nation, and Salt River Pima Maricopa Indian Community.
• Written comments from 417 people (including parents, service providers, and
community advocates) about their community assets, barriers, and priorities.
• Nineteen focus groups during which 82 parents of young children, 12 grandparents
raising young children, and 60 service providers shared their experiences with the
current early childhood development and health system and made suggestions
about improving outcomes for young children.
• Key informant meetings specifically designed to solicit information about the systembuilding efforts needed, the state of the current system, what is working and what
should work better for children and their parents or guardians. Thirty-nine individuals
representing multiple aspects of early childhood development participated, including
educators, health professionals, child care providers, state agency administrators,
family support providers, and private foundation personnel.
The findings presented in this report are based on a rich and comprehensive collection
of data from a wide variety of qualitative and quantitative research sources. The specific
data tables and related statistics are published separately in a companion document,
Arizona’s Early Childhood Data Book, which is available upon request.

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Appendix

Endnotes

See www.naeyc.org
NAFCC accredits home child care providers. To be eligible to apply providers must:
1. Be at least 21 years of age.
2. Have a high school diploma or GED.
3. Provide child care for a minimum of 15 hours per week.
4. Provide care for a minimum of 3 children in the home. At least one child must
live outside the provider’s home.
5. Be a primary caregivers, spending a minimum of 80% of the operating hours
of the home actively involved with children. If applying as co-providers each
applicant must spend a minimum of 60% of the operating hours of the home
actively involved with children.
6. Have at least 18 months experience as a family child care provider before the
observation visit or 13 months experience if home visits are conducted monthly
and intensive training is received.
7. Meet the highest level of regulation to operate a family child care home.
8. Be in compliance with regulations of the licensing body.
9. Accreditation periods begin when accepted after the observation visit and may
end in any month.
3
See US Census, ACS 2006 Table B17001
4
See From Cradle To Career: Connecting American Education From Birth Through
Adulthood: A Special State-Focused Supplement to Education Week’s QUALITY
COUNTS 2007 With Support From The Pew Center on the States at
www.edweek.org/rc.
5
2005 U.S. percentage of 11% verified through the National Center for Health Care
Statistics. The Arizona percentage of 19% for 2005 is from the U.S. Census Bureau,
Current Population Survey, Annual Social and Economic Supplement, 2006. Data for
2005 were updated April 2007. Arizona data for 2000-2004 has been computed by
the Population Reference Bureau and the Urban Institute for Kids Count using Census
Bureau data.
6
See Reading Across the Nation: A Chartbook; Reach Out and Read National Center;
UCLA Center for Healthier Children, Families, and Communities; Boston University
School of Medicine, Boston Medical Center Department of Pediatrics. November
2007.
7
See Compensation and Credentials: A Survey of Arizona’s Early Education Workforce;
and Center for the Child Care Workforce, Estimating the Size and Components of the
U.S. Child Care Workforce and Caregiving Population.
8
See Compensation and Credentials: A Survey of Arizona’s Early Education
Workforce.
9
See U.S. Census Bureau, Population Estimates Program.
10
See U.S. Census; ACS 2005 and ACS 2006.
11
Center for Business Research, L. William Seidman Research Institute, W.P. Carey
School of Business (2004). The economics of early care and education in Arizona.
Tempe, AZ: Arizona State University.
12
See Census 2000, Tables P34 A-H, SF1, ACS 2005 Tables B11001 A-H, SF1.
1
2

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Appendix

Capps, R. & Fortuny, K, Immigration and Child and Family Policy, prepared for the
Urban Institute and Child Trends Roundtable on Children in Low-Income Families,
January 12, 2006.
14
See ACS 2006 Tables S1601 and DP-2 Selected Social Characteristics in the United
States: 2006.
15
See US Census 2000 Tables P20, SF3, and QT-P16, SF3.
16
See Census 2000 and ACS 2006 Table S1101.
17
See U.S. Census, 2005 American Community Survey. Figures are estimates based on
sampling. For some counties no figure is given either because no sample observations
were available to compute an estimate or a ratio of medians cannot be calculated
from the sample observations. Data for prior years is not available because subsets of
question B10001 were not asked on prior American Community Surveys.
18
While Tribal population information is displayed separately, for planning purposes,
the Census data for people living on Tribal lands is included in the State and County
information as well.
19
See U.S. Census, 2005 American Community Survey. Figures are estimates based on
sampling. For some counties no figure is given either because no sample observations
were available to compute an estimate or a ratio of medians cannot be calculated
from the sample observations. Data for prior years is not available because subsets of
question B10001 were not asked on prior American Community Surveys.
20
See Arizona Department of Health Services. Table T-3. Births to unmarried mothers,
teen pregnancies, teen births and rates by county of residence, Arizona 2005, 2006.
21
See Getting Ready, Findings from the National School Readiness Indicators Initiative.
(2005). Rhode Island KIDS COUNT.
22
ibid
23
See 2005 and 2006 American Community Surveys. Figures given are estimates
based on sampling.
24
ibid
25
See Census 2000.
26
See Census 2000. (2003, October). Grandparents living with grandchildren: 2000.
Census Brief.
27
See 2006 American Community Survey.
28
See Arizona Dept. of Economic Security, Research Administration, in cooperation
with the U.S. Department of Labor, Bureau of Labor Statistics, September 2007
29
See ACS 2006 Table DP-3 Selected Economic Characteristics and Census 2000
Table DP-3, SF3
30
See 2005 American Community Survey, Table B17010 Poverty Status in the Past 12
Months of Families By Family Type by Presence of Related Children Under 18 Years
By Age of Related Children.
31
ibid
32
See The Health Status of Urban American Indians and Alaska Natives, An Analysis
of Select Vital Records and Census Data Sources, An Urban Indian Health Institute
Report, March 16, 2004
33
See From Cradle To Career Connecting American Education From Birth Through
Adulthood A Special State-Focused Supplement to Education Week’s QUALITY
13

96

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Appendix

COUNTS 2007 With Support From The Pew Center on the States at
www.edweek.org/rc.
34
2006 data on the number of children 0-5 in poverty is taken from ACS 2006, Table
B17001, Poverty Status in the Past 12 Months by Sex By Age. The universe for this
table is the population for whom poverty status is determined. ACS 2006 reports data
only for places with 65,000 population or greater. Data is available for 10 of Arizona’s
15 counties. 2006 data is not available for Gila, Greenlee, Graham, LaPaz and Santa
Cruz counties. In Census 2000, the number of children aged 0-5 in poverty from
these 5 counties represented
35
ibid
36
See Getting Ready, Findings from the National School Readiness Indicators Initiative.
(2005) Rhode Island KIDS COUNT.
37
ibid
38
The data for this measure come from the 2000 and 2001 Supplementary Survey and
the 2002 through 2005 American Community Survey (ACS). The 2000 through 2004
ACS surveyed approximately 700,000 households monthly during each calendar year.
In general but particularly for these years, use caution when interpreting estimates
for less populous states or indicators representing small subpopulations, where the
sample size is relatively small. Beginning in January 2005, the U.S. Census Bureau
expanded the ACS sample to 3 million households (full implementation). The ACS,
when fully implemented, is designed to provide annually updated social, economic,
and housing data for states and communities. (Such local-area data have traditionally
been collected once every ten years in the long form of the decennial census.)
This measure focuses on teens ages 16 to 19 rather than young adults 16 to 24
because a large share of 18- to 24-year-olds migrate across state lines each year.
The high interstate migration rates confound the connection between state policies
and programs and state dropout rates. Raw numbers are rounded to the nearest
thousand. Data Source: Population Reference Bureau, analysis of data from the U.S.
Census Bureau, Census 2000 Supplementary Survey, 2001 Supplementary Survey,
2002 through 2005 American Community Survey.
39
See 2004 national data from the Health, United States, 2006, U.S. Department of
Health and Human Services. 2004 Arizona data from ADHS Table 5B-13, Births by
Mother’s Education and County of Residence, Arizona, 2004, 2005.
40
See Arizona Department of Health Services. Table 18 – Teenage Births by Mother’s
Education and Age Group Arizona, 2005, and Table 1B-2 – Live Births According to
Selected Maternal, Prenatal Care and Delivery Characteristics, Birthweight, Plurality,
Child’s Sex, Birth Order and Birth Complications Arizona, 1995-2005 (All Ethnic
Groups).
41
See Magnuson, K.A. & McGroder, S.M. (2002). The Effect of Increasing Welfare
Mother’s Education on Their Young Children’s Academic Problems and School
Readiness. Working Paper. Evanston: IL. Northwestern University, Joint Center for
Poverty Research.
42
See Winquist Nord, C., Lennon J., Liu, B. & Chandler, K. Home literacy activities and
signs of children’s emerging literacy: 1993 and 1999. Education Statistics Quarterly,
2(1).

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Appendix

See West, J., Denton, K. & Germino-Hausken, E. America’s Kindergarteners:
Findings from the Early Childhood Longitudinal Study, Kindergarten Class of 199899. Education Statistics Quarterly, 2(1).
44
See Bureau of Public Health Statistics Arizona Department of Health Services Arizona
Health Status and Vital Statistics, Table 5-A, Pregnancies and Pregnancy Rates by
Pregnancy Outcome, and County of Residence, 2006.
45
See U.S. Department of Health and Human Services National Center for Health
Statistics, National Vital Statistics Reports, Volume 55, Number 1.
46
See Arizona Department of Health Services, Prenatal Care in Arizona, 2006, Fact
Sheet.
47
See Kruegar, P.M. & Scholl, T.O. (2000). Adequacy of prenatal care and pregnancy
outcome. Journal of the American Osteopathic Association, 100(8), 485-491.
48
See Bhutta, A.T., Cleves, M.A., Casey, P.H., Cradock, M.M. & Anand, K.J. (2002)
Cognitive and behavioral outcomes of school-aged children who were born preterm:
A meta-analysis. Journal of the American Medical Association, 288(6), 728-737.
49
AZ Department of Health Services, Public Health Services, Bureau of Public Health
Statistics, Advance Vital Statistics By County of Residence, Arizona 2006, Table T-2,
page 4 (2005 data from same table of the Advanced Vital Statstics 2005 report, page
4).
50
ibid
51
2005 U.S. percentage of 11% verified through the National Center for Health Care
Statistics. The Arizona percentage of 19% for 2005 is from the U.S. Census Bureau,
Current Population Survey, Annual Social and Economic Supplement, 2006. Data for
2005 were updated April 2007. Arizona data for 2000-2004 has been computed by
the Population Reference Bureau and the Urban Institute for Kids Count using Census
Bureau data.
52
ibid
53
National Center for Health Care Statistics. (2006). Health, United States, 2005, With
Chartbook on Trends in Health of Americans. Hyattsville, MD: Author.
54
Stoddard, J.J., St.Peter, R.F. & Newacheck, P.W. (2006). Health insurance status and
ambulatory care for children. The New England Journal of Medicine, 330(20), 14211425.
55
2005 figures from Health, United States 2006, National Center for Health Care
Statistics.
56
See Getting Ready, Findings from the National School Readiness Indicators Initiative,
Rhode Island KIDS COUNT, February 2005, p. 24.
57
See State Data Trends for Arizona. [Data sheet]. Child Welfare League of American.
Retrieved 11/05/2007 from http://ndas.cwla.org/data_stats/states/Data_Trends/Ariz
ona%20State%20Data%20Trends.pdf
58
See Arizona Department of Economic Security, Division of Children, Youth and
Families, Administration for Children, Youth and Families, Child Welfare Reporting
Requirements, Semi-Annual Report for the Period April1, 2006 through September
30, 2006, page 25 and Semi-Annual Report for October 1, 2006 through March 31,
2007, page 42.
59
Arizona Child Fatality Review Program. (2007). 14th Annual Report, Arizona
43

98

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Appendix

Department of Health Services
ibid
61
Getting Ready, Findings from the National School Readiness Indicators Initiative.
(2005). Rhode Island KIDS COUNT.
62
ibid
63
See National Assessment of Educational Progress (NAEP)
64
NAEP. The design of the 2000 mathematics assessment allowed for the reporting of
results that included performance data for special-needs students (that is, students
identified by their school as having a disability or being limited-English proficient) who
took the NAEP with accommodations as well as for those students who took the
NAEP without accommodations. Results that include the performance of specialneeds students who were assessed with accommodations are discussed in detail
in The Nation’s Report Card: Mathematics 2000. Non-accommodations figures
for 2000 should be compared to assessments prior to 2000 and accommodation
included figures for 2000 should be compared with subsequent year results. The
results presented in this highlights do not include results for students who participated
with accommodations. This was done so that comparisons can be made to past
assessment results, which did not include accommodated students.
65
The data for this measure come from the 2000 and 2001 Supplementary Survey and
the 2002 through 2005 American Community Survey (ACS). The 2000 through 2004
ACS surveyed approximately 700,000 households monthly during each calendar year.
In general but particularly for these years, use caution when interpreting estimates
for less populous states or indicators representing small subpopulations, where the
sample size is relatively small. Beginning in January 2005, the U.S. Census Bureau
expanded the ACS sample to 3 million households (full implementation). The ACS,
when fully implemented, is designed to provide annually updated social, economic,
and housing data for states and communities. (Such local-area data have traditionally
been collected once every ten years in the long form of the decennial census.)
This measure focuses on teens ages 16 to 19 rather than young adults 16 to 24
because a large share of 18- to 24-year-olds migrate across state lines each year.
The high interstate migration rates confound the connection between state policies
and programs and state dropout rates. Raw numbers are rounded to the nearest
thousand. Data Source: Population Reference Bureau, analysis of data from the U.S.
Census Bureau, Census 2000 Supplementary Survey, 2001 Supplementary Survey,
2002 through 2005 American Community Survey.
66
“Good Quality Child Care: A Dramatic Opportunity to Promote Learning and Prevent
Damage in Our Youngest Children,” Child Care Action Campaign, 1996.
67
ADHS, Office of Child Care Licensing – Licensing Unit Surveyor ratios are based
on the number of surveyor positions filled, not the number of authorized positions,
and the number of licensed/certificated providers. Newly hired surveyors are included
in the count but may not have been assigned a caseload until they are adequately
trained.
68
http://www.azdhs.gov/als/databases/providers_cc.pdf. Based on a total number of
child care centers, public school child care programs and small group homes with
86% receiving visits. 14% of the total is 372.68.
60

First Things First 2007 BUILDING BRIGHT FUTURES

99

Appendix

See Caring for our Children: National Health and Safety Performance Standards.
Caring for our Children: National Health and Safety Performance Standards.
RATIONALE: These child:staff ratios are within the range of recommendations for
each age group that the National Association for the Education of Young Children
(NAEYC) uses in its accreditation program. The NAEYC recommends a range that
assumes the director and staff are highly trained and, by virtue of the accreditation
process, has determined a staffing pattern that enables effective staff function. The
standard for child:staff ratios in this document uses a single desired ratio, rather than
a range, for each age group. In some cases, these child:staff ratios and group sizes
are the more stringent ratios and group sizes recommended in the National Research
Council’s report, Who Cares for America’s Children? Child Care Policy for the 1990s.
According to the National Research Council, child:staff ratios and group size are two
of the four most important areas to be addressed in national standards.
71
See naeyc.org
72
NAFCC accredits home child care providers. To be eligible to apply providers must:
1. Be at least 21 years of age.
2. Have a high school diploma or GED.
3. Provide child care for a minimum of 15 hours per week.
4. Provide care for a minimum of 3 children in the home. At least one child must
live outside the provider’s home.
5. Be a primary caregivers, spending a minimum of 80% of the operating hours
of the home actively involved with children. If applying as co-providers each
applicant must spend a minimum of 60% of the operating hours of the home
actively involved with children.
6. Have at least 18 months experience as a family child care provider before the
observation visit or 13 months experience if home visits are conducted monthly
and intensive training is received.
7. Meet the highest level of regulation to operate a family child care home.
8. Be in compliance with regulations of the licensing body.
9. Accreditation periods begin when accepted after the observation visit and may
end in any month.
73
See From Cradle To Career: Connecting American Education From Birth Through
Adulthood: A Special Supplement to Education Week’s QUALITY COUNTS 2007
With Support From The Pew Center on the States.
74
ibid
75
This percentage was determined by comparing the licensed capacity of centers and
homes from Arizona Department of Economic Security, August 2007 and Arizona
Department of Health Services, Office of Child Care Licensing with population
estimates for the age group.
76
See From Cradle To Career: Connecting American Education From Birth Through
Adulthood: A Special Supplement to Education Week’s QUALITY COUNTS 2007
With Support From The Pew Center on the States.
77
Parents and the High Price of Child Care, 2007 Update; Study conducted and
published by the National Association of Child Care Resource and Referral Agencies;
www.naccrra.org
69
70

100

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ibid
ibid
80
See National Women’s Law Center Issue Brief, State Child Care Assistance Policies,
2007: Some Steps Forward, More Progress Needed, September 2007.
81
ADHS, Prenatal Care Status, Birth Certificate Data Base, 2005.
82
ibid
83
Safe, Healthy and Ready to Succeed: Arizona School Readiness Key Performance
Indicators. (2006). State School Readiness Board. Governor’s Office for Children,
Youth and Families.
84
See Arizona Department of Health Services, Prenatal Care in Arizona, 2006, Fact
Sheet.
85
National Center for Health Care Statistics. (2006) Health, United States, 2005, with
Chartbook on Trends in the Health of Americans. Hyattsville, MD: Author.
86
Safe, Healthy and Ready to Succeed: Arizona School Readiness Key Performance
Indicators. (2006). State School Readiness Board. Governor’s Office for Children,
Youth and Families.
87
Inkelas, M., Regalado, M., Halfon, N. Strategies for Integrating Developmental Services
and Promoting Medical Homes. Building State Early Childhood Comprehensive
Systems Series, No. 10. National Center for Infant and Early Childhood Health Policy.
July 2005
88
See U.S. Department of Education’s 24th report to Congress
89
ibid
90
See Kuklish, K. Prenatal Care in Arizona, 2006 Fact Sheet, Arizona Department of
Health Services.
91
See Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2004. National vital
statistics reports; vol 55 no 1. Hyattsville, MD: National Center for Health Statistics.
2006.
92
ibid
93
ibid
94
Kuklish, K. Prenatal Care in Arizona, 2006 Fact Sheet, Arizona Department of Health
Services.
95
National Center for Health Care Statistics. (2006). Health, United States, 2005, With
Chartbook on Trends in Health of Americans. Hyattsville, MD: Author.
96
2005 U.S. percentage of 11% verified through the National Center for Health Care
Statistics. The Arizona percentage of 19% for 2005 is from the U.S. Census Bureau,
Current Population Survey, Annual Social and Economic Supplement, 2006. Data for
2005 were updated April 2007. Arizona data for 2000-2004 has been computed by
the Population Reference Bureau and the Urban Institute for Kids Count using Census
Bureau data.
97
Arizona Department of Health Services; Arizona Health Care Cost Containment
System Quality Management Performance Measures reports for the periods
ending September 2002, September 2003, and AHCCCS, Division of Health Care
Management, Progress Report on Targets for Children’s Preventive Health Initiatives
for School Readiness, March 2006; and the National Center for Quality Assurance,
National Medicaid Results for Selected 2000 HEDIS and HEDIS/CAHPS measures.
78
79

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Appendix

Arizona Health Care Cost Containment System, October 2007.
2005 figures from Health, United States 2006, National Center for Health Care
Statistics.
100
Arizona Department of Health Services, Bureau of Health Systems Development,
Arizona Health Professional Shortage Areas Fact Sheet.
101
ibid
102
Center for Disease Control, National Oral Health Surveillance System.
103
Head Start Program Information Report for the 2005-2006 Program Year. Profile
Report – State Level Summary.
104
Arizona Department of Economic Security, Part C State Annual Performance Report,
and National Early Childhood Technical Assistance Center, Table 6-1. Infants and
toddlers receiving early intervention services under IDEA, Part C, by age and state:
Fall 2005.
105
Arizona Department of Economic Security, Part C State Annual Performance Report,
and National Early Childhood Technical Assistance Center, Table 6-1. Infants and
toddlers receiving early intervention services under IDEA, Part C, by age and state:
Fall 2005.
106
Table 1-11. Children ages 3 through 5 served under IDEA, Part B, as a percentage
of population, by disability. OSEP reported data. IDEAdata.org.
107
Source American Academy of Pediatrics Committee on Early Childhood, Adoption,
and Dependent Care; Pediatrics Vol. 107 No. 1 January 2001.
108
Source. In Care of Our Children: How Arizonans Perceive the Quality of Life for
Children in Our State; Valley of the Sun United Way. 2005.
109
ibid
110
ibid
111
ibid
112
Reading Across the Nation: A Chartbook; Reach Out and Read National Center;
UCLA Center for Healthier Children, Families, and Communities; Boston University
School of Medicine, Boston Medical Center Department of Pediatrics. November
2007.
113
Email communication with Bonnie Groth, Title I Even Start Director, Arizona
Department of Education.
114
See Compensation and Credentials: A Survey of Arizona’s Early Education Workforce;
and Center for the Child Care Workforce, Estimating the Size and Components of the
U.S. Child Care Workforce and Caregiving Population.
115
ibid
116
ibid
117
ibid
118
U.S. Department of Labor, Occupational wages, May 2001, May 2004, May 2006
and 2006 U.S. Department of Labor wages data file. The U.S. Department of Labor
defines “preschool teacher” as a person who instructs children up to five years of age
in activities designed to promote social, physical, and intellectual growth for primary
school in a preschool, day care center, or other child development facility and may be
required to hold State certification. “Preschool teacher” in this distribution excludes
special education preschool teachers.
98
99

102

First Things First 2007 BUILDING BRIGHT FUTURES

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See Compensation and Credentials: A Survey of Arizona’s Early Education Workforce;
and Center for the Child Care Workforce, Estimating the Size and Components of the
U.S. Child Care Workforce and Caregiving Population.
120
Clifford, D. Engaging the Public on Behalf of Young Children: Practical Considerations
and Strategies in Building Public Will to Support Early Childhood Services.
121
Source: In Care of Our Children: How Arizonans Perceive the Quality of Life for
Children in Our State, Valley of the Sun United Way, 2005.
122
ibid
123
ibid
124
The Early Childhood Health and Development Initiative. Presented by Nadine Mathis
Basha, Smart Start Conference, May 10, 2007.
125
Source: In Care of Our Children: How Arizonans Perceive the Quality of Life for
Children in Our State, Valley of the Sun United Way, 2005.
126
Lally, J. Ronald, Lerner, Claire, and Lurie-Hurvitz, Erica; National Survey Reveals
Gaps in the Public’s and Parents’ Knowledge about Early Childhood Development;
Young Children, March 2001; p 49.
127
ibid
128
ibid
129
ibid
119

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103

Photo courtesy of Native American Connections,
Photographed by Leroy Dejolie

104

First Things First 2007 BUILDING BRIGHT FUTURES

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