The blog of the Urban Institute
November 10, 2021

How Targeted Health and Wellness Efforts Can Strengthen the Home-Based Child Care Workforce

November 10, 2021

Home-based child care providers have been the “unsung heroes in the COVID-19 crisis,” as many stepped up to continue services despite nearly 40 percent of the child care workforce losing their jobs in February 2020. Nearly 18 months into the pandemic, the child care system continues to struggle and parents continue to face child care disruptions, as 30 percent of parents with children younger than 5 reported in early October that their children were unable to attend child care in the past four weeks because of safety concerns.

During the pandemic, as many larger child care facilities were forced to close, home-based providers—including licensed family child care programs and informal friend, family, and neighbor caregivers—continued caring for children, putting their own physical safety at risk. Many took pride in being essential workers who helped keep the economy running.

Yet research shows this workforce is underpaid, earning near-poverty wages. Home-based providers work long hours with few breaks and often lack employee benefits and connections to resources. Even before the pandemic, the health and well-being of this workforce was concerning, with 11 percent of all home-based providers (licensed and not) lacking health insurance and 28 percent  reporting fair or poor health in 2019. The pandemic has only exacerbated these health inequalities.

How states can support the wellness of home-based child care providers

The influx of child care funding from the American Rescue Plan and other COVID-19 relief packages gives states a unique opportunity to invest in efforts to support home-based providers. The Biden administration in particular is urging states (PDF) to use the funds to support the early childhood workforce because of shortages, with a direct mention of mental health and wellness supports.

Although experts have identified strategies to support the larger early care and education workforce, home-based providers have some unique needs. Many home-based providers are relatives or have close relationships with the children they care for, provide care in a home setting (usually their own) versus a child care center or school, and often work independently or with a single partner or assistant. These providers need supports that acknowledge these specific realities, such as home visiting services and infant and early childhood mental health consultation adapted for home-based child care.

Home visiting is a service delivery approach where a designated support person—typically a trained nurse, social worker, or early childhood specialist—goes into a family’s home to work directly with an adult caregiver (typically parents) to support children’s health and development by providing education, support, and connections to local community services. Many communities also offer mental health consultation to child care providers to help prevent, identify, and treat mental health problems among children younger than 6. These programs equip providers with skills, knowledge, confidence, and connections, resulting in more positive caregiving interactions and more positive outcomes for children and families.

But the current reach of these services is limited. To extend services to home-based providers, states can take several steps.

  1. Take inventory of home-based providers throughout the state and the capacity of mental health consultation services and local home visiting programs.
  2. Leverage existing home-based child care networks, or build new networks to serve as a central hub for home visiting and mental health consultation services.
  3. Improve cross-program service coordination to identify gaps and avoid the duplication of efforts toward providers who already participate in quality improvement initiatives or other similar coaching activities.
  4. Be mindful of the unique realities of home-based child care and the differences among home-based providers (e.g., relative caregivers, licensed businesses) when adapting or expanding program models to ensure services meet each provider’s needs.

Investing in support services such as home visiting and mental health consultation can give child care providers the tools they need to be successful, boosting the quality of care provided and workforce retention. These services offer an important opportunity for strengthening and sustaining this essential workforce as many child care providers are left burned out and disillusioned by the current state of the industry.


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DULUTH, MINNESOTA - OCTOBER 18: WeeCare Childcare owner Erica Hanson monitors the play of her daughter, Sydney, 2, along with the other children enrolled in her small at-home daycare program on a crisp fall day in Duluth, Minnesota on Friday October 18, 2019. (Photo by Melina Mara/The Washington Post via Getty Images)

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