Promotion of early childhood development and mental health in quality rating and improvement systems for early care and education: A review of state quality indicators.

• Quality Rating and Improvement Systems use indicators to define early care and education quality. • Indicators often offer evidence-informed guidance to support and monitor development and foster mental health. • Development and mental health promotion often applies to center-based and family child care. • Opportunities exist to offer more specific guidance in quality indicators. • Future research can assess equity of child development and mental health promotion indicators. In the United States (U.S.), quality rating and improvement systems (QRIS) are used by many states to incentivize quality in ECE and may be a viable lever for promoting early childhood development and mental health on a population level. We conducted a qualitative review of publicly available data on state QRIS indicators to better understand how states incorporate evidence-informed early childhood development and mental health promotion standards in QRIS. We systematically compared QRIS indicators for 41 U.S. states with child development and mental health promotion quality standards from Caring for Our Children National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition , as of March/April 2020. Of those, 39 states included at least one indicator consistent with child development or mental health promotion standards, including practices that can lead to early detection of developmental delays such as developmental monitoring, activities or curriculum addressing developmental domains, and regular communication and resource-sharing with parents/guardians. Opportunities exist within states for incorporating more specific guidance within indicators, such as use of childcare health consultants and advocates, validated screening tools, parent/guardian participation or input in developmental monitoring and screening, and staff training on family engagement. We found that in most states QRIS indicators offer guidance for ECE systems to support and monitor early development and foster mental health, with opportunities to enhance guidance. Findings point to QRIS as a viable opportunity for promotion of early childhood development and mental health standards in ECE systems. [ABSTRACT FROM AUTHOR]