More than a decade ago, Celia Sims sat in a room with parents whose precious children had died while at day care. Most had been neglected by their caregivers. Some died from injuries, others in their sleep. 

Most of the children attended licensed facilities, and at the time, their parents believed that licensing meant providers were safe, that unqualified workers were screened out. But they weren’t. 

In the early 2010s, there was no federal requirement that child care providers undergo background checks. Fewer than a dozen states required a comprehensive check of criminal, child abuse and sex offender registries — most of the others only checked one, if that. Once these children died, police investigations revealed that providers at their care centers had past convictions for crimes like manslaughter and sexual abuse, Sims said. These people, the parents said, should not have been working in child care, period. 

The parents were outraged—and rightly so, Sims remembers thinking. It seemed so unnecessary. So preventable. 

“After that, you can’t just close your eyes and walk away,” said Sims, who was then a senior staffer for former Sen. Richard Burr, a North Carolina Republican. She got to work. 

Burr and then-Sen. Barbara Mikulski, a Democrat from Maryland, worked with members of the child care advocacy community to draft bipartisan legislation that would, for the first time, establish national safety standards for child care. It would ultimately make its way into the 2014 reauthorization of the Child Care and Development Block Grant (CCDBG), the national funding mechanism. States use the money they receive from the grant to reduce the cost of care for low-income children and improve that care by implementing safety and licensing requirements. But to get the money — at least in theory — states must abide by CCDBG rules.

And those rules would be stricter than ever. The reauthorization introduced eight background check requirements that state agencies must run on child care job applicants: two federal checks, of the FBI fingerprint and sex offender registries. Three state ones, of the criminal history, sex offender and child abuse registries. And three more interstate checks of the same state registries in any state where a provider lived during the previous five years. All of these checks were meant to screen out people with a history of crimes like child abuse, assault or endangerment. As part of the new CCDBG rules, states would also be required to post inspection reports online and collect data on serious incidents. It was a statement of values: The government was saying that this was the nation’s standard for child care, no matter where a program was located. 

States had until 2018 to come into compliance.

But 10 years after the law took effect, many states are still failing to uphold at least one of its components. 

According to a 2022 report to Congress analyzing the issue, at that time 27 states failed to conduct at least some, if not all, of the checks and hiring practices required by the law. Nineteen allowed staff to start working with children before background checks were completed. Nearly all of the states had been hampered by old technology systems, state bureaucracy and databases that range from incomplete to downright inaccurate.

It’s unclear where states stand today. The federal Office of Child Care, the regulatory agency that is meant to oversee states’ progress on fixing these problems, told The 19th that only three states had updated some of their policies since the report was published (New Hampshire, for example, no longer allows staff to start work before checks clear), but all 27 remain out of compliance because they do not yet conduct every required check. Yet several states disputed the agency’s determination and provided detailed documentation on their background check procedures, opening the possibility that even the regulatory agency can’t say for certain where states are falling short. 

The winding, chaotic path towards fixing these issues has baffled child care advocates. “I have not been able to understand why, in some states, this hasn’t been a big deal,” said Sims, who went on to found The Abecedarian Group, a child care and education consulting agency.

But it is a big deal.

Background checks are a critical safety requirement in most jobs, but especially when it comes to safeguarding small children who may not be able to express when something has gone wrong. Yet the haphazard enforcement of these rules means that, in some states, barriers to child care jobs are too high, while in others they are not high enough. States with the most stringent requirements have made it more difficult for day care providers to hire workers, and for people to join a workforce of much-needed caregivers. That’s creating additional barriers for in-home care providers, who are disproportionately women of color and are often the most accessible caregivers in low-income communities.

In states where the systems to run the checks are still not meeting federal standards, difficult questions remain about whether the screening mechanism meant to shield kids from injury, abuse and even death is functioning as it should.

A decade later, no one can yet quite say what the right balance is between protecting children and protecting the child care sector.

“You never want a child to be hurt on your dime — it is a terrible, terrible thing. If we didn’t do everything possible to protect every child, we have fallen down on our job,” said child care expert Danielle Ewen. “If you don’t have the systems in place to keep kids safe, who are you actually protecting and who are you hurting?”

At the root of this snarl is the reality that while the federal government made the rule, 50 different states have to carry it out. Each does it in their own way, with procedures that are often incompatible.

For example, in 2014, interstate checks were added as a commonsense safeguard. Policymakers wanted to ensure caregivers didn’t hop from job to job in different states, evading screening along the way, particularly in areas like Washington D.C. and Virginia, where workers may live in one state but work in another. But over time, those checks have come to illustrate why the system itself is broken. 

Eleven states didn’t run interstate checks at all, the 2022 report found. Nine didn’t respond to other states’ requests. Some checks can’t be run because of simple — and mystifying — bureaucratic reasons: One state accepts credit card payments and the other doesn’t, for example. 

States also have differing laws about what information they can share across state lines, and with what agencies. After a request is submitted, states can decide whether to provide all the records they hold on a person, only conviction information, or simply to give a “yes” or “no” determination as to whether that person is eligible to work in child care based on their local laws. 

That matters because states have different thresholds for what constitutes an offense that would prohibit someone from working with children. For example, a teenager who gets arrested for urinating in public might be considered a sex offender in one state, but not another. When that teenager applies for a job in a new state, their background check might indicate that yes, they have been arrested for a sex offense — but not give any context about what it was.

Tribes are also subject to the requirements of CCDBG, but none of them were given legal authority through the 2014 law — or any other, for that matter — to independently run federal background checks. To get around that, some tribes have had to ask states to submit requests on their behalf, creating the same problem: Child care workers may be disqualified based on state rules instead of tribe rules. 

Much of the information in the abuse registries is also incomplete or unreliable. The 2022 report to Congress, which was put together by an interagency task force, found that some states include unsubstantiated abuse cases as well as substantiated ones. That means people could be disqualified from working even if the allegations against them were found to have had no merit. 

Domestic violence survivors have particularly suffered as a result. In some states, they show up in registries not because they caused the abuse, but because an investigator determined that they failed to protect a child from the perpetrator or from witnessing the violence.

“Consequently, victims of domestic violence can remain on [abuse] registries for years, regardless of whether the individual themselves would be unsafe to provide care in a child care program,” the report found. 

Experts have also questioned the racial and economic biases of the registry system, especially when it comes to flagging child neglect. About 75 percent of all child welfare cases are the result of neglect, not violence, and about half of states define neglect as a failure to provide basic needs. Caregivers living in poverty, the majority of whom are people of color, may get flagged simply because they’re unable to find affordable housing, for example. 

“How much do we trust the gatekeeping mechanism to be fair and equitable?” asks Gina Adams, a child care expert at the Urban Institute who has studied the racial disparities inherent in background checks for child care. “The challenge is that, to the extent that it finds true situations of child abuse or child risk, it is an important mechanism to protect children — so I strongly support that.”  

“However,” Adams continued. “I worry that because of inequitable policing, it may be also keeping out a whole bunch of people who should not be kept out.”

These inefficiencies have put a heavy burden on child care providers, who have seen how time consuming and burdensome it can be to run background checks, and how the wait can mean they lose staff to other employers. And they’ve also wondered: How much are the background checks keeping out people who want to — and should — work in care? How often are they letting the wrong people through?

Just last year in New York City, a 1-year-old died of a fentanyl overdose at a day care that was a front for a drug operation. The providers had passed background checks. Reports also revealed the city had a backlog of 140 child care background checks at the time. 

In Washington state, provider Susan Brown has been wrestling with this question after 35 years in the child care business. As part of the federal law, prospective staff who pass a fingerprint check — either of the federal FBI registry or the state criminal history registry — are allowed to start working while their other checks are being completed. But Washington is more restrictive: Nobody can work until they pass the five federal and state checks. For Brown’s employees, the drive to just get their fingerprints taken can take hours roundtrip. The entire background check process can take up to a month, she said. Why would a worker wait that long when they can get a job tomorrow at a fast food restaurant and get paid about the same wages?

“Child care providers can’t afford to pay them until they’re in the classroom,” said Brown, the president and CEO of Kids Co., a chain that provides child care services across Seattle. And she pointed to another problem: Day cares have been short-staffed since the pandemic, and that’s limiting how many classrooms can be open and how many students can be enrolled. “Now with the crisis being what it is, because no one has any extra staff, you can’t even enroll kids to cover the wages of the person.”

Brown also questions why so many requirements have been imposed on child care providers, and not people in similar professions, like teachers. “We’ve had, over the years, the situation where we tried to hire public school teachers and they didn’t pass the background check,” Brown said. (In Washington, teachers need to only pass two checks — an FBI check and a state patrol check.)

The racial disparity is undeniable, Brown said. Women of color are overrepresented in the child care workforce and also face more scrutiny to enter jobs that are among the lowest paid in the country. Meanwhile, the majority of the teaching workforce is White women. 

In a January letter to the state, signed by more than 300 child care providers, Brown wrote: “This disparity is not only unjust, but perpetuates systemic racism within our regulatory framework. Washington State’s current background check process magnifies the inequity by removing the possibility of beginning supervised work after completing a fingerprint background check, as outlined in federal requirements.” 

In Washington, the state performs the five federal and in-state background checks together. Changing the process to do just the fingerprint checks first, so workers can start sooner, “would take a lot of resources and time to develop,” because all the results are currently submitted as one package, said a spokesperson for the Washington Department of Children, Youth, and Families. “We made the decision to comply with federal regulations by requiring the completion of all background check components for this reason.” It takes about eight days on average to complete the checks once fingerprints are submitted, according to Washington state’s most recent 2024 data. 

Home-based providers feel the inequity of these checks most directly, because not only do these workers need to be background checked, but so does every adult who lives in the home. 

In-home child care is for many low-income families the only viable option, and it’s often run by women of color — women whose families are more likely to live intergenerationally and to come into contact with the criminal justice system or the immigration system. 

“It deters folks from becoming licensed,” said Natalie Renew, the executive director of Home Grown, which works to improve home-based child care. “They perceive risk.” 

But what happens when states are also too accommodating? The risk is that children could be put in the care of harmful or negligent people — the exact situations the federal requirements were designed to eradicate.

That was the problem the Congressional task force was meant to help solve. Previous reports from 2022 and 2021 had concluded that numerous states fell short of requirements. But the task force’s version, published by the Department of Health and Human Services, was the first to try to quantify which states were out of compliance, and why. The Office of Child Care then took on studying each state’s individual challenges and creating a plan to fix them. 

Some states do seem to be lagging. Mississippi, for example, doesn’t check the national sex offender registry, a spokesperson for the state Department of Health told The 19th. Still, the state refutes the 2022 report, which noted that Mississippi did not have policies in place to conduct any of the checks as required by the 2014 law. The Mississippi spokesperson said that the information was dated.

When The 19th asked the Office of Child Care whether any of the information in the 2022 report was outdated, it listed only three states as having made improvements since the report was published, though it considers all 27 to still be out of compliance. Mississippi was not on the list. (The states were New Hampshire, Alabama and Washington.)

In fact, several states disputed the Office of Child Care’s determinations. The 19th reached out to officials in five states that had significant issues flagged in the 2022 report, and which the federal agency still considers to be out of compliance. Many said those issues had either been partially or completely rectified.

For example, according to the report, West Virginia only runs one of eight required checks. But Whitney Wetzel, a spokesperson for the West Virginia Department of Human Services, told The 19th that determination “should not be considered current.” 

Wetzel said the department “is confident that it is compliant with all statutory and regulatory background check requirements,” and provided a list of the checks performed, including the FBI fingerprint check and national sex offender check, as well as the in-state criminal, sex offender and abuse registries. 

New Jersey was flagged in the report for failing to run checks on a sub-group of providers, those who are license-exempt, but a spokesperson for the state Department of Human Services confirmed to The 19th that it has been running checks on those providers since mid-2021.

Other states are in more of a gray area. According to the agency, Alabama only recently created policies to run in-state, federal and interstate checks, and remains out of compliance with other aspects of the background check law. However, a spokesperson for the Alabama Department of Human Services told The 19th: “All checks required under the Child Care and Development Fund rules are performed,” and the discrepancy is only in how the federal office would like the state to structure the process. Alabama is in the process of updating its background check procedures, but the current system “still covers all the required checks,” the spokesperson wrote. 

Vermont was the only state flagged in the 2022 report for allowing staff to start working with children unsupervised before fingerprint background checks were cleared. But the deputy commissioner for the state’s child development division, Janet McLaughlin, told The 19th that while the state does allow new staff to start working before those checks are finalized, that work is supervised. That is, however, still out of compliance with the federal rule.

The Office of Child Care did not respond to The 19th’s requests to clarify the discrepancies between its records and the states’ assertions. But an official from the Administration for Children and Families, which oversees the agency, told The 19th that the agency worked with state child care agencies and their partners to create plans to identify what staffing, technology and infrastructure investments they’d need to come into compliance. 

The agency went through an intensive process to document each state’s background check policies, the official said, and that study revealed gaps. 

But now, because of the disagreements between states and the agency,  it is hard to say how close each has come to filling them.

All of this begs the question: If the regulatory agency that oversees the states could be wrong, how will the problem ever get fixed?

The more time that goes by, and the longer states have been out of compliance, the more states have also started to question whether what is being asked of them is even doable, Ewen said. She was the director of the Child Care and Early Education team at the Center for Law and Social Policy when the CCDBG rules were being crafted. 

“If you have a system where people start to believe that you can’t achieve the end goals, they are not incentivized to try. They’re more incentivized to try and go to Congress and say, ‘This doesn’t work’ instead of going to their state leaders and saying, ‘We’re gonna get dinged for this in an audit,’” Ewen said. 

Linda Smith, the former executive director of Child Care Aware, the advocacy organization whose research was critical to the creation of the safety standards, said the federal government has long been too lenient with the states. In her view, it’s past time that the issue be resolved.

“These are some of these things that if you want to do it — you do it,” Smith said. “I don’t think there was ever any excuse for not doing them. We are talking about the basic safety of children who can’t talk.”  

Yet the 2022 report — and the fact that the Office of Child Care has not credited any state with coming into full compliance since it was issued — pointed out some uncomfortable truths. Yes, some states have delayed compliance. And yes, some tried but faced truly significant challenges. It’s also clear by now, a decade later, Sims said, that “we got some things wrong in the statute.” 

The abuse registries were a “mess,” she said. And some of the things that seemed commonsense, like interstate background checks, turned out to be much more complicated than anyone had realized. 

Grace Reef, then the chief of policy at Child Care Aware who conducted the initial research on the issues with background checks, said the intention behind the law was sound: “to help protect kids and give parents some peace of mind,” she said. 

But they were operating with limited information about the quality of the data in the registries and the state laws that would make it difficult, in practice, to conduct all the checks they felt were important. “We had trouble trying to figure out how to structure language,” she recalled. “You do the best you can.” 

Advocates insist there has to be a middle ground. And changes are coming. 

This year, for the first time, states will be required to answer detailed questions in their state child care plans regarding the remaining obstacles they face with background checks. Each state needs to submit their plan, a roughly 300-page document that outlines how its system works, by July 1. 

At the state level, advocates like Lorena Garcia, the CEO of the Colorado Statewide Parent Coalition, are working to ensure that her state narrows the list of offenses that would disqualify someone from working. Garcia works with what are known as family, friend and neighbor providers: registered but unlicensed in-home providers who also need to undergo checks, but might be hesitant to do so because they live with people who have some kind of criminal record or because they are in mixed immigration status households. She wants to make sure only offenses that would affect the safety of children are counted. 

To address the interstate checks, Cindy Mall, the senior program director of the California Child Care Resource & Referral Network, sees the National Fingerprint File (NFF) as the most obvious solution. Twenty-four states participate in the FBI-maintained fingerprint database, which makes performing interstate checks a relatively simple experience. If all states were a part of it, more could come into compliance, Mall said — including California, which the report currently lists as out of compliance on performing the national sex offender registry check and the three interstate checks.  

For her, the issue comes down to a question of resources. It’s not enough to say something is a priority without the support to make it happen. In 2022, President Joe Biden tried to pass a $400 billion child care plan that would have given states funding they could have used to improve their systems and increase staffing. But that effort ultimately failed after Sen. Joe Manchin, the Democrat from West Virginia, withdrew support from the package saying it was too costly and expansive.

The task force that studied the background checks came to a similar conclusion. Even if the states followed every recommendation the group laid out, they wrote, “full implementation of the current array of checks is unlikely without major additional fiscal investment and changes to state laws not addressed in this report.” 

“It comes down to money,” Mall said. “Money is staffing, money is resources, money is databases.” 

It also comes down to political will. Burr and Mirkulski have since left the Senate and few champions remain. But the problems linger. Since the pandemic, child care as an industry has been on life support, kept alive through a one-time federal investment that allowed states and programs to get the resources they needed to improve their systems. 

But that money was temporary — the needs aren’t. Safety remains as important as ever.

“Ten years into this,” Reef said, “we ought to have sufficient information in a bipartisan way, not to make it a partisan issue, but to make sure the law works as intended by commonsense approaches. I think that’s what’s needed.” 

This story was produced by The 19th and reprinted with permission.

The post States are required to background check child care workers. Many are falling short appeared first on The Hechinger Report.

Doubts swirled from the start.

After Cynthia King’s baby Wiley Muir died suddenly at a home-based day care in Honolulu, she fixated on the things that seemed off. The medical examiner said he died of pneumonia, but Wiley hadn’t been sick that morning. King wondered how sickness could take him so suddenly — how they could have missed that.

But most of all, there was the notebook, which King began keeping just four days earlier, when Wiley started at the day care. On the morning of February 6, 2014, King had jotted down what time her 4-month-old had woken up and what he’d eaten. That notebook had gone with Wiley to day care that morning and was returned to King at the police department days after his death.

The page she’d started the day he died was gone, ripped out. Instead, there was a new page rewritten in the day care owner’s handwriting.

“That freaked me out. Why on Earth, on the day he died, would the day care provider rip out the page and rewrite what I had already started writing?” King said.

A year and a half later, on what would have been Wiley’s second birthday, King and her husband ran into Therese Manu-Lee, the provider caring for Wiley when he died. She was wearing scrubs and appeared to be working with an elderly person. King wondered what happened to the day care.

Later, King looked her up online. The day care had been shut down by the state.

Right away, King called the Department of Human Services, which oversees the state’s child care office. Manu-Lee’s license was suspended while police investigated Wiley’s case but reinstated when the case was closed. It was shut down again a year later in 2015 when a surprise inspection of Manu-Lee’s home found her with 14 children in her care, eight of them infants — four times the legal number of infants for a home-based provider.

The doubts rushed back.

Related: A daycare center accused in baby death can keep operating

“That sort of overwhelming feeling of, ‘Oh my God, I knew she was lying to us about something, but I didn’t know what’” took over, King said.

That revelation set in motion years of battles: first with the police department to reopen Wiley’s case, and then with the state’s child care agency and the Hawaii legislature to push for new legislation that could make child care safer.

Beginning in 2016, King, an entomologist, sat on a Hawaii child care working group in the legislature and advocated for about a dozen regulation bills. But she could get only one new law through — an update requiring day cares to take on liability insurance. The Wiley Kaikou Muir Act passed in 2017.

Among King’s larger priorities was passing a law requiring Hawaii to post child care inspection violations online and track serious incidents, creating a window into the state’s child care safety efforts. But King was told at the time by state officials that Hawaii didn’t need that law — a child care safety movement at the federal level was about to do just that. 

In 2014, the same year Wiley died, the country’s central funding mechanism for child care, the Child Care and Development Block Grant (CCDBG), was reauthorized by Congress with new requirements. CCDBG sends money to states to subsidize care for low-income children, and because every state takes CCDBG money, they all have to comply with its rules.

Until 2014, the block grant had paltry health and safety requirements. States didn’t have to run background checks on child care providers or collect data on deaths or serious incidents.

So no one knew, really, how many kids were getting hurt at child care across the country — how many were dying.

Although child care was and still is very safe, cases of children dying in day cares from preventable causes started to gain national attention in the early 2000s. That helped advocates launch what would become a nearly decade-long campaign in Congress to weave better health and safety guidelines into CCDBG.

New requirements passed into law with broad bipartisan support in 2014. Among them: For the first time, states would be required to start collecting and posting data around the numbers of deaths, serious injuries and substantiated abuse cases at day cares. Databases also needed to go online, allowing parents to search providers and see inspection reports and violations in their state. A series of federal, state and interstate background checks were also made mandatory. States had until October 2018 to come into compliance.

Ten years after those rules around health and safety were put in place, over a dozen states are failing to fulfill all the reporting requirements, an in-depth analysis from The 19th found.

After an inquiry from The 19th, the Office of Child Care, the federal regulatory agency that oversees states’ child care systems, confirmed that eight states are out of compliance. The 19th found an additional nine states that are missing data or have outdated information online. Six states updated their reports when The 19th pointed out errors or missing data.

Related: How the military created the best child care system in the world

In the process of reporting this story, The 19th reached out to more than 40 advocates, experts and organizations in the child care and child welfare space. Few knew anything about where the states stood on the reporting requirements in CCDBG. Some didn’t know about the requirements at all.

Linda Smith, a child care expert who was instrumental in getting the regulations passed, said states have been given too much latitude to comply. Neither the Office of the Inspector General for the Department of Health and Human Services nor the Government Accountability Office have audited the states to ensure they were following the reporting provisions, both offices confirmed.

“For the most part, they are sort of operating outside of the traditional system and accountability,” said Smith, now the director of the early childhood development initiative at the Bipartisan Policy Center, a nonpartisan think tank.

Systems like background checks and data tracking are key safety mechanisms in any industry. Food service inspection violations are posted online and in restaurants. Accidents with airlines are also posted online, even though, like in child care, they are also fairly rare.

Overall, the number of deaths at day cares is very low, often in the single digits annually in each state, and some states haven’t had any at all for the past several years. Among the 30 states and Washington, D.C., that published 2023 data, California had the highest number of deaths last year: 10; one child died at a child care center and nine died at in-home day cares. The two states with the next highest numbers last year were Texas at six deaths and Montana with five.

Data on injuries and abuse is murkier. States can decide how they define these cases — some count any instance that requires medical attention, others count only injuries that cause permanent damage — leading to widely different numbers. Georgia, for example, had zero serious injuries in 2022; Ohio, which also counts serious “incidents,” had nearly 19,000. 

There is also no federal reporting requirement, meaning the data lives at the state level, in reports that are difficult to find and, in some cases, difficult to understand.

Celia Sims, a former senior staffer for Sen. Richard Burr, the North Carolina Republican who spearheaded the changes to CCDBG, said they took on the issue more than 10 years ago because tallying cases is one of the only ways to ensure safety for really young kids.

“You can’t count on your 6-month-old to tell you that something is wrong when you pick them up in the evening,” Sims said. “That’s why it’s even more important that things, when they are substantiated, get reported.”

The intent behind the requirements was also to create transparency for parents. But Sims said she’s been surprised to discover just how hard it is to even find the information. Most reports are buried in state websites, under titles like “aggregate report” or “federal reporting,” and hyperlinked in the middle of a paragraph. It’s not the easily accessible, plain language vision that was laid out in CCDBG.

“I was a little taken aback,” said Sims, who went on to found The Abecedarian Group, a child care and education consulting agency. “Wow, I couldn’t find any of them.”

Related: How to make improvements to Mississippi child care

The reporting requirements aren’t the only issue. More than half of states are also out of compliance with the law’s new background check requirements, which called for five checks and three interstate checks that have to be completed within 45 days for all child care staff. For home-based day cares, that also includes adults living in the house who may come in contact with children. According to a 2022 report to Congress from an interagency task force convened to study the issue, 11 states are not conducting any interstate checks and 19 states are allowing child care staff to be hired before background checks were completed. Those numbers remain current, the Office of Child Care confirmed.

The 19th also analyzed if states had fulfilled a third requirement of creating online databases of all the state’s child care providers with inspection and violation data.

Only one state was out of compliance on all three categories: Hawaii.

Hawaii hasn’t posted any data at all from the past seven years on serious injuries and abuse at day cares. The last year it reported was 2016, making it the only state with a reporting gap that wide. The online database of violations King advocated for a decade ago — the one she was told was coming soon in 2016 — is still not up. Hawaii is also one of the states not running interstate background checks on child care providers.

The reasons why are various, but underpinning Hawaii and the other states’ compliance issues is a difficult reality. The child care system in the United States has been described by the Treasury Department as a “textbook example of a broken market.” It is losing day cares to financial constraints and a lack of federal investment. To ensure safety, day cares have to stick to strict ratios of children to teachers. That means staffing costs make up a huge portion of the budget, but that also means the staff is paid close to minimum wage, leading to high turnover. Raising wages would mean raising fees for parents, many of whom are paying more than their rent or mortgage on child care.

But when CCDBG was reauthorized, Congress did not substantially increase the program’s budget to help states implement the new safety requirements. Some of what ultimately happened was that states didn’t make safety improvements right away, Smith said. And now a decade later, some still haven’t.

None of the states have been penalized for it, the federal Office of Child Care confirmed. In Hawaii, where an extraordinarily high cost of living meets an extraordinarily low child care supply, parents don’t always report all the red flags they see at a center for fear it’ll close down and they’ll have nowhere to take their kids, King said.

That is a challenge that needs a solution, but it shouldn’t mean accountability is lost, King said. And it shouldn’t now be up to the parents whose children have already been lost to push for a better system.

“It’s so inappropriate that the onus is on the families of victims, when this should be coming from the state or federal level,” King said. “There’s something that’s really very difficult about being a group of people where everybody is not whole. That’s why nothing is happening. Because everyone is hurting tremendously.”

***

Until the early 2000s, very little was known at a national level about incidents at child care centers. A 2005 report by researchers at the City University of New York Graduate Center put together the first — and so far only — comprehensive national study of deaths in child care, cobbling together reports published in media outlets, legal cases and some state records.

They found 1,362 fatalities in child care from 1985 through 2003, 75 percent of them in home-based care, both licensed and unlicensed.

“Key to any effort aimed at reducing risks is gathering consistent, reliable data on fatalities, serious injuries, and near misses in child care,” they wrote.

Child Care Aware, a national child care advocacy group, then took the issue on, releasing an analysis of state rules and regulations around safety every year from 2007 to 2013. Their work paved the way for Congress to act in the 2014 reauthorization — the new rules all came from the organization’s recommendations.

Related: Where are the missing child care directors?

Smith was the executive director of Child Care Aware at the time, and she and Grace Reef, the chief of public policy, led that effort.

“You think that licensing means something, but what we were exposing at the time was: not really,” Reef said. “There were states that did an inspection once every 10 years — are you kidding me?”

The CCDBG requirement ultimately shaped up like this: States must produce data every year on the number of deaths, serious injuries and cases of substantiated abuse at child care. The numbers for death and serious injury were to be broken down by the type of program incidents took place in — center-based or home-based, for example— and the data had to be published online and easily accessible.

Here’s where we stand, 10 years later.

As of 2024, California is the only state that still doesn’t post serious injury or abuse data online at all.

Alaska and Wisconsin don’t provide breakdowns by the type of child care facility serious injuries took place in. Vermont didn’t either for serious injuries and deaths until The 19th asked about it and, realizing an error that occurred with a change of staff, the state updated its website the next day.

Wisconsin, which failed to include data on four deaths in its 2021 report, updated it after The 19th’s questions. Wyoming, which wasn’t posting data on substantiated abuse cases, added the figures when The 19th inquired. Alaska provided additional data to The 19th via email, though it hasn’t yet made it public.

The 19th also found one state with outdated statistics: South Dakota’s most recent data is from 2021. New Hampshire hadn’t published data since 2020, but after The 19th inquired, the state posted 2023 data in January.

Delaware, Kansas and New Jersey have all been flagged by the Office of Child Care for not posting complete data on license-exempt providers. The 19th’s own analysis found that Arkansas, Nebraska and Oklahoma are not reporting data on those providers. Delaware, Kansas, Missouri and Oregon have also failed to include totals for the number of kids in child care, another required part of the regulation. Illinois was also missing that data point but added it after The 19th asked about it.

The federal office marked Mississippi and New York as out of compliance as of the end of 2023, but both states updated most of their data online, though Mississippi still appears to be missing annual data. The federal office also flagged West Virginia for posting incomplete data on in-home providers, but the state said it hadn’t received such a notice and that it would be updating its data this month.

Even in states that are reporting data, some of it is confusing and contradictory. In Nevada, the child care division is in the process of changing departments, and that has led to two different reports online: In one published by the welfare division, the abuse cases in 2020 numbered above 3,000. In the 2020 report from the licensing department, the number of abuse case referrals is 48.

When The 19th asked about the discrepancy in Nevada’s data, Karissa Loper Machado, the state’s agency manager for child care, said she wasn’t sure how the first report was calculated. After the state looked into it, it said the data it had been publishing as its child care numbers also included cases in private homes and foster care, leading to the higher figures. The state expects to have its data updated in the next six months to a year.

Nevada also doesn’t report how many of its abuse cases turn out to be substantiated. The licensing department doesn’t keep track of it, so the state doesn’t report it.

“We are working to come into compliance,” Loper Machado said. 

Related: What is it like to run a child care provider in one of America’s poorest states?

In the 10 years since the CCDBG reporting requirements were created, states have been given a lot of autonomy in deciding what gets counted as serious injury and abuse and what doesn’t. In 2018, the Office of Child Care told state child care agencies to consider changing their definitions so that only programs with the most egregious cases were penalized. Some states changed their definitions, and others did not.

In Georgia, cases are put on a scale — low, medium, high or extreme harm or risk — and only extreme cases now get reported, said April Rogers, the child care services director of policy and enforcement at the Georgia Department of Early Care and Learning.

Georgia lists two serious injuries in 2023, and both of those programs lost CCDBG and state funding as a result of that determination, said Ira Sudman, the department’s general counsel, and programs with “high”-level injuries can still potentially incur penalties.

By contrast, in Ohio, the state counts all serious injuries and incidents, covering everything from deaths (which get double counted) to COVID-19 cases. There were 18,788 serious injuries or incidents in Ohio in 2022, the most recent year for which there is data. Even without including COVID cases, the number is still 4,762 — at least 10 times what many other states are reporting. In early 2017, the state put in an automated reporting system that allowed day care owners to report serious incidents quickly online.

Reef said that over the years, state legislatures have battled over what they should count in the numbers. But for the data to be tracked well, there need to be requirements of day care owners, too, state child care agencies said.

All of the data on deaths, serious injuries and abuse is self-reported by the day care providers themselves typically through forms they submit to the states. The states do inspections of the providers to make sure they are following safety requirements, but several states, including Georgia and Missouri, told The 19th they don’t know how accurate those reports are because they’re relying on the day cares to submit them.

What’s missing is “political will around forcing private business to give us data they clearly do not want to give us,” said Pam Stevens, Georgia’s deputy commissioner for child care. “We would love to know everything because it would help everybody.”

In Missouri, Nancy Scherer, the administrator of the state’s Office of Childhood, said getting day cares to report is the highest hurdle they face.

“I think they’re afraid: ‘If I report that, I’m going to have a violation, they’re going to shut me down,’” Scherer said.

And those are the providers the state knows about.

In 2021, eight children died in Missouri day cares. Seven of those deaths took place in unlicensed child care, which the office isn’t tracking because it doesn’t license them. Deaths are tallied instead through tips that come in.

“We don’t know about it, until we know about it,” Scherer said.

***

After King learned that her son’s provider had been shut down by the state of Hawaii, she asked to see his full police case file. For the first time, she also brought herself to read his autopsy in its entirety.

Those files contained numerous inconsistencies — vindication that King had been right to have her doubts.

Manu-Lee told police Wiley was in her arms when he died, but she told the ambulance crew that she’d put him down for a nap and later found him unresponsive. And in the autopsy, Wiley’s cause of death was not pneumonia, but bronchiolitis, which affects a different part of the lungs than pneumonia.

The autopsy findings helped King push the police to reopen the case, but ultimately prosecutors told her there wasn’t really an avenue to pursue. Detectives didn’t have any evidence of abuse or trauma.

The 19th reached out to Manu-Lee via phone and email, but she did not respond to requests for comment. In 2016, she told Civil Beat that, “the child was ill. It was not my fault.”

King was, however, able to have other pediatric forensic pathologists examine Wiley’s autopsy, who determined he could not have died from bronchiolitis or pneumonia. In Honolulu, the medical examiner admitted to King, she said, that he’d put that cause of death to give her a sense of closure.

The cause of death was ultimately changed to “undetermined.”

“It was hard emotionally to have to justify to people again and again why having an incorrect cause of death provided to us was so damaging and counterproductive toward finding out what really happened,” King said. “When the cause of death was changed, in some ways it was sort of a relief.”

Related: For Mississippi parents, child care costs lead to tough choices

King refocused on legislation, but while she waited for Hawaii to implement the requirements of the federal law, she became disheartened. By 2017, the new requirements were still not in place, and King, still pushing for new laws, pleaded with the state.

“I am asking you to change this shockingly broken system and instill real accountability,” she testified at a hearing for what would go on to be another failed child care accountability bill.

In 2019, past the deadline for states to come into compliance with federal regulations, Hawaii still hadn’t implemented the changes. King still hadn’t had more luck with legislation. And she was pregnant. By the time COVID-19 shut the world down, King realized there was no hope in pushing for changes in an industry that was being decimated by the pandemic. Nothing would pass. So she moved on.

She hadn’t looked back into whether the state had kept its promise of publishing data and creating its day care database until The 19th called her near the end of 2023.

Hawaii is now the state most behind in implementing the federal child care safety requirements.

The state told The 19th it is struggling to do so with a licensing department made up of only three people. The entire Human Services Department has a vacancy rate of about 25 percent.

Dayna Luka, the child care regulation program administrator in the Hawaii Department of Human Services, told The 19th that the state isn’t posting recent data because it has not finalized its definitions of serious injury and abuse. Without a definition, Hawaii can’t track the data, and it’s not posting it online. It’s the only state that doesn’t have its definitions finalized, The 19th’s analysis of the states’ child care plans found.

The process of creating definitions is long and requires public hearings and comments, Luka said. The last time Hawaii had a public hearing for child care regulations was in 2021, she said.

“We may not be reporting that data because we don’t have the definition, but we are definitely investigating any kind of allegation of injury, any kind of violation of our licensing rules,” Luka said. 

The state said it is asking the federal office for technical assistance to begin reporting serious injuries and abuse, but it didn’t provide a timeline for when it will begin doing so. It hopes to have its day care provider dashboard, as well as inspection reports, online by the summer. For now, it contracts with the state’s child care resource and referral agency for its child care provider database, but that dashboard doesn’t include inspection reports.

On a national level, it is impossible to know how many cases are not getting reported or investigated in child care because there is so much that falls into a gray area, said Christopher Greeley, a professor of pediatrics at the Baylor College of Medicine who has spent more than two decades studying pediatric abuse and neglect. And those investigations are further complicated because of their charged, emotional nature, leading to inaccurate recollections, as well as witnesses who may not be verbal.

“The narrower question of, ‘Is this injury abuse versus not?’ becomes quite fraught with difficulty because we all may agree the child has a broken bone, but now I’m adding a value judgment of whether that was done intentionally or not and some of that information may not be available,” Greeley said. That’s in part because some states don’t even have the capacity to thoroughly investigate those cases.

Advocates have been calling for more funding for the child care system, which could help states finally meet all of the safety requirements in CCDBG. A national effort to inject $400 billion over 10 years into child care failed in 2022, and other proposals haven’t found traction. It’s a hard truth in child care: A system that has been under-resourced for its entire existence can’t solve the big problems if it’s fighting to exist in the first place.

“One of the reasons that we talk about the need for a comprehensive system is that we understand then that the data would also be easier to track,” said Nina Perez, the early childhood national campaign director at MomsRising, a national network of moms pushing for child care and other family policies. “Any parent would tell you that they absolutely want reporting and transparency, particularly in instances of neglect and harm. This is a situation where the government needs to step up and resource that, including state governments.”

Anne Hedgepeth, the current chief of policy and advocacy at Child Care Aware, said states and child care providers “understand the seriousness or importance of the work they’re doing.” But “ultimately, licensing is complex and not every state system is sufficiently funded to do this work. Until we fix that problem, reporting won’t be as robust or transparent as it needs to be.”

When the country considers what another reauthorization of CCDBG might look like in the coming years, more support for compliance on health and safety could be areas marked for improvement, said Smith, who crafted the 2014 reauthorization. She wants to see the Government Accountability Office audit the states. And it could be a time to revisit whether the data needs to be reported at the federal level.

Through her own work, King understands the complexities of data collection. She worked at a state agency and knows what it means to be under-resourced, for things to take time. But she also carries the burden of being a parent who has lived through the death of a child that happened — at least in part, she feels — because the accountability wasn’t there.

A decade after her son’s death, she is still often struck by how many of the systems that are in place for other industries aren’t yet standard in child care. King, who this week marked the 10-year anniversary of her son’s death, said she was shocked to learn Hawaii was still so behind.

“I have been chronically disappointed in the level of response,” King said. “I understand that everybody is overtasked and under-resourced but I do think it’s such an important issue. It’s been devastating to not see progress made.”

Since Wiley died, King has had two more children, a boy and a girl — children she’s had to leave at the door of a provider after her trust was shattered.

“My husband and I are both lucky that we came out on the other side of Wiley’s passing away,” King said, but when it came time to decide where to put their children, they put their trust somewhere else.

They found a day care provider who they felt was taking all the safety precautions necessary, who was keeping the number of children they cared for low and who let the families into their space. A person who did everything possible to ensure they weren’t reported.

Ultimately, King turned away from the system that was built to ensure safety. The system that failed her.

Instead, she put her children in unlicensed care.

This story was produced by The 19th and republished with permission.

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