Quality in Norwegian childcare for toddlers using ITERS-R...Quality in Norwegian childcare for...

This version of the article has been accepted for publication by Taylor and Francis in

EECERJ Volume 26 Issue 1, 2018

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Quality in Norwegian childcare for toddlers using ITERS-R Elisabeth Bjørnestad and Ellen Os

Abstract:

The purpose of this study was to explore the quality of toddler childcare in Norway using the

Infant Toddler Environment Rating Scale Revised (ITERS-R; Harms, Cryer, and Clifford

2006), drawing on a sample of 206 toddler groups. Possible associations between quality (as

assessed using ITERS-R) and selected structural features in toddler classrooms were

investigated. Those features are as follows: ownership, the presence of qualified teachers, the

staff-to-child ratio, and group organization. According to the results, Norwegian toddler care

scored at the minimal level of quality. The presence of qualified teachers, high staff-to-child

ratios, and small and stable groups all seemed to have positively impacted quality. Detailed

analyses revealed that Norwegian toddler classrooms did not fulfil the ITERS-R requirements

for hygiene, safety, and access to play materials. Because of the good reputation Norwegian

childcare enjoys, these results were unexpected and suggest the need to enhance the quality of

Norwegian toddler care.

Keywords: group organization; ITERS-R; play materials; preschool teacher, quality; staff-to-

child ratio; toddler childcare

Author: Elisabeth Bjørnestad, Department of Early Childhood Education, Oslo and Akershus University College of Applied Sciences. Corresponding authors e-mail: [email protected] Co-author: Ellen Os, Department of Early Childhood Education, Oslo and Akershus University College of Applied Sciences.

mailto:[email protected]



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Quality in Norwegian childcare for toddlers using ITERS-R 1 Elisabeth Bjørnestad2 and Ellen Os3

Introduction

The Nordic model of early childhood education and care (ECEC) enjoys a reputation for providing

high-quality care to children (OECD 2006). Internationally, Norway’s holistic approach to children’s

well-being, learning, and development – along with structural aspects of its ECEC – seems to be

highly regarded (OECD 2015). Nevertheless, questions concerning the excellence of the Norwegian

ECEC system have been raised, both nationally and internationally (OECD 2015; Whitepaper 19

2015-2016).

In recent years, access to ECEC in Norway has increased rapidly, with nearly every Norwegian child

entering childcare in the second year of life. Norwegian ECEC has undergone structural changes that

have occurred simultaneously with this growth in enrolment. Traditionally ECEC centres have been

relatively small, consisting of few groups and only 3 or 4 classrooms, but this period of growth has led

to a shift towards larger centres (Vassenden, Thygesen, Bayer, Alvestad, and Abrahamsen 2011). At

the same time, changes related to group composition have taken place, resulting in a movement from

the traditional units of small and stable groups to larger and more flexible groups (Riksrevisjonen

2009).

No research to date has monitored the rapid growth in Norway of ECEC attendance by toddlers and

the accompanying structural changes (OECD 2015). As a result, knowledge concerning current

Norwegian ECEC quality is limited. In addition, research in ECEC is mainly based on qualitative, in-

depth studies. Even if these qualitative studies contribute to valuable knowledge, there is a lack of

large-scale research (Bjørnestad, Pramling Samuelsson, Bae, Gulbrandsen, Johansson, Løberg, and Os

2012; OECD 2015). A recently published OECD report (2015, 58-60) recommends the initiation of

large-scale studies of ECEC in Norway to monitor the quality of care using reliable and valid

instruments such as the Infant/Toddler Environment Rating Scale (ITERS-R) (Harms, Cryer, and

Clifford 2006).

1 Support for this research was provided by The Research Council of Norway (BePro 220570/ Searching for Qualities 218322). 2 This study is a part of the Better Provision for Norway’s Children in ECEC (BePro) project with the following Key Investigators: Elisabeth Bjørnestad, Jan Erik Johansson and Lars Gulbrandsen (Oslo and Akershus University College); Marit Alvestad and Eva Johansson (University of Stavanger); Liv Gjems and Thomas Moser (University of Southeast Norway); Edward Melhuish (Oxford University) and Jacqueline Barnes (Birkbeck University of London). 3 This study is a part of the Searching for Qualities project with the following Key Investigators: Leif Hernes, Ellen Os, Nina Winger, Brit Eide and Tona Gulpinar (Oslo and Akershus University College), Torill Vist (University of Stavanger), Anne Myrstad and Toril Sverdrup (The Arctic University of Stavanger).



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This article is based on results from two ongoing research projects, ‘Better Provision for Norway’s

Children in ECEC4’ and ‘Searching for Qualities5’, both of which aim to explore different aspects of

quality in toddler day care. Both projects comprise several studies with a variety of thematic and

methodological approaches in small, in-depth studies as well as large-scale studies. As a part of the

large-scale studies, the international tool ITERS-R6 has been utilized for the first time to investigate

quality in Norwegian toddler care. To our knowledge, this is the most extensive observational study of

the quality of Norwegian ECEC ever undertaken.

The aims of this study is to explore:

a) the features that characterize quality in ECEC for toddlers in a Norwegian context, as assessed

using ITERS-R

b) possible associations between quality assessed using ITERS-R and selected structural features

in toddler classrooms: ownership, presence of qualified teachers, staff-to-child ratio, and

group organization.

Quality toddler childcare Debates concerning quality in ECEC have taken place since the 1970s. While the concept of quality

appears to be the subject of endless debate, the general consensus holds that quality is related to

processual and physical characteristics (Bjørnestad et al. 2012; Kontos, Burchinal, Howes, Wisseh,

and Galinsky 2002; Sanders and Howes 2013). Processual aspects of care such as interactions both

between staff and children and among children seem to contribute directly to children’s development.

Structural characteristics such as group size, staff-to-child ratio, organization, and materials work

more indirectly, through their impact on processual aspects: ‘Structural dimensions predict process

dimensions, not children’s development’ (Sanders and Howes 2013, 358). Some studies (Kontos et al.

2002; Kontos and Keyes 1999) expand the concept of quality by explicitly including content as an

aspect of bidirectional relations.

In Norwegian, Nordic, and international research in general, there is a lack of knowledge concerning

the quality of centre-based care for toddlers (Bjørnestad et al. 2012). Most research related to childcare

quality and children’s development, for example, the EPPE project (Sylva, Melhuish, Sammons, Siraj-

Blatchford, and Taggart 2004), has focused on children of preschool age.

4 «Better Provision for Norway’s Children in ECEC” (BePro) (in Norwegian, “Gode barnehager for barn i Norge” (GoBaN) is a longitudinal project following children from 2.6 years until 5 years. BePro assesses quality in ECEC obtained by both ITERS-R and ECERS-R. 5 “Searching for Qualities” (in Norwegian, “Blikk for Barn”) focus mainly on children aged 0–3 years and their everyday life in different group compositions obtained by both ITERS-R and qualitative approaches. 6 Baustad (2012) piloted ITERS-R in a few groups in her master thesis.



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Bjørnestad et al. (2012) sum up some of the key factors that go into high-quality toddler care. The

most important factors are sensitive interactions and good relationships between staff and children and

between children within a given group. High-quality centres are described as settings with high staff-

to-child ratios, staff stability, small group sizes, and well-trained staff members. For infant and toddler

groups, 1:3 is regarded as the optimal staff-to-child ratio, and the optimal group size for children under

the age of 2 seems to be 6–8 children per group. The combined effects of process quality and

structural quality are important for the overall quality in toddler care.

Recent and ongoing Norwegian and Nordic research have paid attention to what consequences

organization and group size may have for children’s learning environments. Organization in large,

flexible, or open groups gives those groups a home base while they share interest centres and areas for

routines and care with other groups. The interest centres are often housed in areas that are located at a

distance from the home base. Flexible groups involve a changing mix of children and caregivers

across various rooms that might undermine interactions between children and staff and between the

children. Almost all studies researching group organization find the same tendencies. Small, stable

groups seem to be crucial for high-quality learning environments that promote children’s interaction

and communication as well as their learning and development. In bigger and more flexible groups,

children seem less likely to have close relationships with the staff because the latter must care for

many children. Larger group size may also have implications for peer interactions and children’s

involvement in relation to materials and activities (Alvestad, Bergem, Eide, Johansson, Os,

Pálmadóttir, Pramling Samuelsson, and Winger 2014; Pramling Samuelsson, Williams, and Sheridan

2015; Seland 2009; Sheridan, Williams, and Pramling Samuelsson 2014; Skalická, Belsky, Stenseng,

and Wichstrøm 2015; Vassenden et al. 2011). Skalická et al. (2015, 960-961) underscore: ‘…, it

would seem more difficult for children experiencing large spaces, different rooms, and flexibly

changing staff to develop close relationships with their teachers, relative to children who experience a

“smaller” – and perhaps more intimate social world.’

Another question raised in ECEC quality debates concerns the potential effects of attending childcare

institutions on children’s development and learning (Melhuish 2001). Studies examining the combined

structural, process, and content dimensions of quality have demonstrated associations between high

ECEC quality and children’s short-term and long-term developmental outcomes in social, emotional,

and cognitive development (Belsky, Vandell, Burchinal, Clarke-Stewart, McCartney, and Owen 2007;

Burchinal, Roberts, Nabors, and Bryant 1996; Sylva, Melhuish, Sammons, Siraj-Blatchford, and



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Taggart 2011; Vandell, Belsky, Burchinal, Steinberg, and Vandergrift 2010)7. Research also calls

attention to the impact experiences in toddlerhood have on school readiness (La Paro, Williamson, and

Hatfield 2014; McCartney, Dearing, Taylor, and Bub 2007). Fenech (2011) reports that classrooms

measured with ITERS-R have lower total scores than classrooms measured with ECERS-R. The low

ITERS-R scores indicate that it is necessary to gain knowledge about quality in toddler childcare in

order to make improvements.

In recent years some European countries have included ITERS-R in their studies related to quality in

ECEC. A study from the UK (Karemaker, Mathers, and Singler 2012) assesses the quality level of

toddler care as minimal (M=4.0). Studies from Portugal (Barros and Aguiar 2010) and the Netherlands

(Helmerhorst, Riksen-Walraven, Deynoot-Schaub, and Fukkink 2015) score the quality level of

toddler care in those countries as inadequate (respectively M=2.8 and M=2.9). An ongoing study in

the UK (Melhuish and Gardiner 2017) reports an increase in the UK quality rating from minimal in

2012 to good (M=5.3) in 2017. The scores for both the Netherlands and Portugal are minimal in the

area of Interaction and inadequate in the categories Activities and Personal Care Routines*. The UK

(2017) receives a good score for Interaction (M=5.6), Personal Care Routines (M=5.3), and Activities

(M=4.8) (see tables 1 and 3).

Table 1: Overview of ITERS-R scores for UK (2012, 2017), Netherlands (2015), and Portugal (2010

UK 2012 Netherlands Portugal UK 2017

N = 247 N = 55 N = 160 N = 402

M (SD) M (SD) M (SD) M (SD)

Space and Furnishings 3.9 (.90) 2.7 (.63) 3.3 (.74) 5.5 (1.06)

Personal Care Routines 3.6 (1.2) * 1.7 (.53) 5.3 (1.15)

Listening and Talking 4.6 (1.1) 3.5 (1.09) 3.4 (.98) 5.1 (1.25)

Activities 3.5 (1.0) 2.3 (.56) 2.44 (.56) 4.8 (1.01)

Interaction 5.1 (1.2) 3.8 (1.25) 3.7 (1.10) 5.6 (1.14)

Program Structure 4.5 (1.3) 3.5 (1.18) 2.56 (.65) 5.4 (1.24)

Total 4.0 (.90) 2.9 (.60) 2.8 (.48) 5.3 (.99)

Note: *In the Dutch study, the category Personal Care Routines is excluded

7 Most of the studies mentioned focus on children from the age of 3 and day care quality measured with ECERS-R or equivalent tools.



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Infant/Toddler Rating Scale – Revised (ITERS-R) ITERS-R, designed by Harms et al. (2006), measures the quality of childcare for children aged 6

weeks to 30 months. Together with ECERS-R, ITERS-R is perhaps the most widely used instrument

for measuring quality in childcare settings (Vermeer, van IJzendoorn, Cárcamo, and Harrison 2016).

ITERS-R covers different aspects of quality: physical arrangement, materials and activities, routines,

supervision, interactions, and schedule. Because of its wide scope, ITERS-R can be regarded as a tool

for investigating global quality (Hestenes, Cassidy, Hegde, and Lower 2007) even if the authors of the

scale refer to ITERS-R as a tool for measuring process quality (Harms, Cryer, and Clifford 2006).

ITERS-R is based on research from relevant fields such as health, development, and education; it also

takes into account professional views of best practices (Harms, Cryer, and Clifford 2006, 1).

Although ITERS-R is highly regarded, like ECERS-R, it is met with considerable criticism.

Developed in the United States, the rating scale’s relevance in non-American cultural settings has been

questioned (Dickinson 2006; Mathers, Singler, and Karemaker 2012). Further, the scale’s global

approach might imply that the measurement is superficial and lacks clarity as to which aspects of

quality constitute its focus (Dickinson 2006; Fenech 2011). Another criticism of the ITERS-R is that it

places too much weight on the structural aspects of childcare (Sanders and Howes 2013, Vermeer, van

Ijzendoorn, de Kruif, Fukkink, Tavecchio, Riksen-Walraven, and van Zeijl 2008) and fails to observe

and assess in depth the interactions that are considered key aspects of quality in childcare (Bisceglia,

Perlman, Schaack, and Jenkins 2009; Cassidy, Hestenes, Hegde, Hestenes, and Mims 2005;

Helmerhorst, Riksen-Walraven, De Kruif, Vermeer, Fukkink, and Tavecchio 2014). The hierarchic

organization of the quality scales, with basic needs at low levels and more educational and

interactional aspects at higher levels, has been criticized, as has the stop-scoring procedure (Gordon,

Hofer, Fujimoto, Risk, Kaestner, and Korenman 2015). The stop-scoring approach means that

requirements on lower levels must be met before scoring higher levels. When a classroom fails to meet

requirements, the observer stops scoring. This procedure limits information about classroom

weaknesses and strengths; if requirements for basic needs are not met, information about interactional

aspects, which are scored at higher levels in the scale, will not be gathered. Further, the highest level

measured in the ITERS-R scale, excellent, may not always reflect true excellence according to some

research (Mathers, Linskey, Seddon, and Sylva 2007; Os and Bjørnestad 2016). Lambert, Williams,

Morrison, Samms‐Vaughan, Mayfield, and Thornburg (2008) find that ITERS-R is appropriate for

measuring quality in childcare settings at or below the medium level, but the scale is not suitable for

distinguishing between settings at higher levels. Combining ITERS-R with more specific, in-depth



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measures might be a way of making the most of the advantages of ITERS-R while compensating for

its weaknesses (Farran and Hofer 2013; Mathers et al. 2007; Sanders and Howes 2013) 8.

Despite this critique, ITERS-R does have advantages. First, ITERS-R is designed to give an overall

evaluation of the quality of children’s learning and developmental environments. The evaluation is

based upon observations of the whole setting, not individual children. Second, the extended use of

ITERS-R in an international context offers opportunities to make comparisons between countries.

Third, because the scale’s time efficiency it is suitable for large-scale research that is highly needed in

Norway (OECD 2015; Whitepaper 19 2015-2016; Whitepaper 24 2012-2013; Whitepaper 41 2008-

2009).

Method

Sample The sample in the current study includes 206 classrooms with 2811 children from 93 centres selected

using stratified random selection (SRS) and self-recruitment in 4 counties in Norway. The distribution

is representative of the Norwegian population. A minimum of 1 staff member in all but 3 of the

classrooms held a bachelor’s degree or higher in early childhood education and care. After several

requests based on SRS and self-recruitment, the distribution consisted of 63% municipal and 37%

private centres. However, an independent sample t-test showed no significant differences in the total

ITERS-R scores between municipal and private centres (municipal M= 3.93, SD= .78, private

M=3.81, SD= .81, t(204)=1.03, p=0.304). These analyses confirmed that our data is not skewed by

the overrepresentation of municipal centres. The sample was also divided between small and stable

groups with their own classrooms (8–19 children) and more flexible groups of 20–56 children that

share classrooms and interest centres (known as “basebarnehager”). The sample’s breakdown is 25.3%

large and flexible groups and 74.7% small and stable groups.

Measurement ITERS-R is organized along seven subscales: Space and Furnishings, Personal Care Routines,

Listening and Talking, Activities, Interaction, Program Structure, and Parents and Staff (Parents and

Staff is not a part of this study). Distributed among the subscales are a total of 39 items, each of which

in turn consists of several indicators. Each item is rated on a scale from 1 to 7 (1= inadequate, 3=

minimal, 5= good, and 7= excellent). The ratings are based on 3–4 hours of observation followed by

8 In our study, we use the Dutch tool CIP to examine/measure the interaction quality.



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an interview with the class teacher to gain information about aspects the observer was not able to

observe during the visit.

The original scoring procedure in ITERS-R has a “stop-scoring” approach. Low-level indicators must

first be met before scoring indicators for higher levels. In the current study, all indicators were scored

even if the groups did not meet the requirements at lower levels; this approach gives a more nuanced

picture of classrooms’ strengths and weaknesses. However, this alternative scoring procedure does not

affect the ITERS-R scores; it just gives more information. For discussions concerning indicator levels,

see Os and Bjørnestad (2016).

Before analysing the data with descriptive statistics, the researchers checked the internal consistency

of the subscales and items. Following the practice of most studies using ITERS-R, we report

Cronbach’s alpha. However, the power and limitations of Cronbach’s alpha have been questioned

(Raykov 2004). The small number of items in each subscale may cause low Cronbach’s alpha.

Therefore, Raykov’s Composite Reliability has also been computed.

Table 2: Cronbach’s alpha and Raykov’s Composite Reliability for ITERS-R items and subscales

N # of items α rho

All items* All Subscales

Space and Furnishings

206 206

206

30 6

5

.87

.84

.52

.87

.86

.52

Personal Care Routines 203 6 .52 .54

Listening and Talking 206 3 .66 .73

Activities* 206 9 .56 .55

Interaction 206 4 .81 .82

Program Structure* 205 3 .56 .58

Note: Cronbach’s alpha and Raykov’s Composite Reliability are reported in this table for the ITERS-R subscales. *Item 23 and 32 are excluded due to missing values.

Coefficients for the full scale were α .87 and rho .87, using 30 items (excluding items 23 and 32), and

α .84 and rho .86 for all subscales. Considering variations in the organization of Norwegian childcare,

these results are acceptable. Computing Cronbach’s alpha and Raykov’s Composite Reliability for

each defined subscale resulted in coefficients that were lower than reported in the ITERS-R scoring

manual. Table 2 shows a low α and rho for all subscales except Interaction (α .81 and rho .82). Both

tests indicate the same reliability level in all subscales except Listening and Talking, where the rho

(.73) is higher than α (.66). With low α and rho in most of the subscales, it is necessary to proceed

with caution in analyses on subscale level.



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Training and data collection Both authors (the leading researchers) were certified through an ITERS-R online course at ersi.info,

followed by an intensive training and reliability check with Debby Cryer. The reliability score

received was 96%. The procedures prescribed by ERSI9 were also followed in training the Norwegian

data collectors. Due to variances in organizational settings, it was decided to have few observers (2–4

in each region, for a total of 12 observers). The interrater agreement within one scale point for all

observers was 87.5. Data collection ran from October 2013 to April 201510 in a total of 206

classrooms.

Adaptations and clarifications Given the cultural bias in the ITERS-R scale, it has been adapted for use in a Norwegian context.

Some of the adjustments take the form of clarifications concerning how indicators express themselves

in Norwegian ECEC. Other minor adjustments have to do with Norwegian cultural beliefs concerning

childhood (e.g. an emphasis on outdoor play and sleeping outside regardless of weather conditions,

along with the expectation that every Norwegian child should appreciate nature from a very young age

(Tandberg og Kaarby 2017). For further information about details concerning clarifications and

adaptations, see www.goban.no for the ITERS-R addendum11.

Results and discussion

Overall Classroom Quality The average total ITERS-R score in Norway is 3.9, defined as a minimal level of quality. Of all

classrooms, 8.75% scored 5 or above (good). None of the classrooms scored at the high levels of 6 or

7 (excellent). The highest total score was 5.9. The vast majority of the classrooms (78.15%) scored in

the minimal range, from 3–4.99. Out of all classrooms, 13.1% scored below 3 (inadequate quality).

A comparison of ECEC quality in Norway versus some other European countries indicates that

Norwegian ECEC is at the same level (minimal) reported in the UK in 2012. However, although

Norway (with a score of 3.9) has a total score close to that of the UK (with a score of 4) and higher

than the ITERS-R total score for the Netherlands (2.9) and Portugal (2.8), compared to the new results

from the UK´s SEED study (Melhuish and Gardiner 2017), Norway’s quality is ranked much lower.

One of the reasons for the increase in quality in the UK between 2012 and 2017 might be that ITERS-

R has been highlighted at the practical, research, and policy levels in the UK (Mathers et al. 2007;

9 ERSI (Environment Rating Scale Institute) 10 During the period from mid-June to mid-August, Norwegian day care centres close for the summer holidays, and from mid-August to mid-September most centres are busy enrolling new children. We therefore chose not to collect data during those periods of adjustment to avoid interference. 11 Only in Norwegian

http://www.goban.no/



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Mathers, Linskey, Woodcock, and Williams 2013; Mathers, Singler, and Karemaker 2012; Ofsted

2015).

Quality in Norwegian toddler groups at subscale level

Table 3: Descriptive Statistics for ITERS-R Subscales - Norway N Mean SD Min Max Skewness Kurtosis

Space and Furnishings 206 3.8 .90 1.80 6.40 .13 -.15

Personal Care Routines 203 3.5 1.00 1.17 6.50 .41 .11

Listening and Talking 206 4.3 1.37 1.00 7.00 -.24 -.72

Activities* 205 3.5 .77 1.78 5.44 .18 -.20

Interaction 206 4.7 1.50 1.00 7.00 -.30 -.84

Program Structure* 205 4.4 1.31 1.67 7.00 .06 -.70

ITERS-R total score 206 3.9 .80 1.64 5.9 -.11 -.07

Note: *Excluded items: item 23 in subscale 4 (Activities) and item 32 in subscale 6 (Program Structure)

Quality at subscale level in Norwegian ECEC, as presented in table 3, ranges from an average score of

3.5 for both Personal Care Routines and Activities to a score of 4.7 for Interaction. None of the

subscales achieve scores of 5 or above. This indicates minimal quality at subscale level. However,

almost all the subscales have a wide distribution. Three subscales, Listening and Talking, Interaction,

and Program Structure, have scores ranging from the maximum score (7) to the minimum (1). The

subscale Activities has the most restricted range: no classrooms scored above 5.44.

The Norwegian results at subscale level show the same patterns as results from the UK, the

Netherlands, and Portugal, where the subscales Interaction and Listening and Talking scored the

highest and Activities and Personal Care Routines scored the lowest. Norway and the UK (Karemaker,

Mathers, and Singler 2012) have similar scores for all subscales, with the exception of the subscale

Interaction, for which the UK scored in the good quality level range while Norway scored in the

minimal quality level range. Both Dutch (Helmerhorst et al. 2015) and Portuguese ECEC (Barros and

Aguiar 2010) scored in the inadequate range in relation to the subscale Activities, and Portugal scored

in the inadequate range in Personal Care Routines.

These patterns indicate that all countries face challenges related to the quality of their ECEC when it

comes to Personal Care Routines and Activities.

To explain the results in Norwegian ECEC at subscale level, it is necessary to take a closer look at the

results at item level, and to a certain degree at indicator level as well.



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Quality at item level Few studies report results at item level; it is therefore difficult to compare what causes the results at

subscale level and what in turn accounts for total ITERS-R scores in different studies. The current

study addresses this problem by examining results at item level to highlight factors that constitute the

total ITERS-R scores and also subscale-level scores. This approach is designed to reveal the strengths

and weaknesses in the care provided in Norwegian toddler classrooms (See table 4: Descriptive

Statistics for ITERS-R Item scores (appendix a) for results at item level).

At item level the scores for Norwegian ECEC range from 2.0 (the item Blocks) to 5.9 (the item

Greeting/departing) 12. Five of thirty items have scores under 3, which means that the quality in these

items is considered inadequate according to the ITERS-R standard (see table 4). Twenty-one items

have a score that falls within the minimal range (from 3.0 to 4.99). At the level characterized as good

(from 5 to 6.99) there are only 4 items (Greeting/, Helping children use language, Sand and water

play, and Staff-child interaction). A closer look into the details regarding different items reveals that

Norwegian ECEC faces some challenges concerning quality when it comes to sanitary procedures,

safety, and materials for activities and play.

Five of the six items in the subscale Personal Care Routines have a mean score of 3.5 or below. The

common denominator seems to be lapses in sanitary procedures. Hand washing procedures connected

to meals and diapering or use of the toilet are often insufficient. The alternate scoring in this study

reveals that many groups met the requirements of higher indicators related to interactions and

education in these items (see Vermeer et al. 2008).

Children’s safety is considered in several indicators in the items: Room arrangement (3.5), Nap (3.5)

and Safety practices (3.1). Regarding these items, the staff does not appear to fulfil the requirements

related to supervision, despite adjustments designed to make these requirements achievable in a

Norwegian context (e.g. using classrooms that consist of several rooms). The supervision during

naptime and play was inadequate. Sometimes children played out of their caretakers’ sight for up to 20

minutes.

The scores for items within the subscale Activities were surprisingly low. Three of nine items – Art,

Music and movement, and Blocks – all scored in the inadequate range. Only one item, Sand and water

play, scored in the good range (5.5), while the rest of the items in this subscale, except for Active

physical play (4.8), scored in the lower part of the minimal range (<4). It is worth noting that the

activities scoring highest were to a large extent outdoor activities, which are highly regarded in

12 Items 23 and 32 are excluded.



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Norway. The reason for the low scores for activities is mainly tied to children’s minimal access to toys

and materials. Lack of materials also affected the scores for Provision for relaxation and comfort:

requirements for soft toys often went unmet. The same is true of the score for Using books because

many groups failed to meet requirements for access to books. Sometimes the groups had the required

materials but stored them out of the children’s reach. Vermeer et al. (2008) report that the particular

emphasis on materials for learning and play is the main factor responsible for low ITERS-R scores in

the Activities subscale in the Netherlands. According to their study, the ITERS-R requirements that

certain quantities of materials must be made available to children are US standards of toddler care that

may not be appropriate in a Dutch context. But it is also possible that the lack of materials in

Norwegian toddler groups has other reasons, such as the way the centres are organized (see below)

and ideas about toy-free environments in Norwegian ECEC (Kjørholt 2016).

Items related to language and interactions received relatively high scores, but it is worth noting that

Helping children use language and Staff-child interaction did not score higher than 5 (good) despite

the relatively low requirements for this score in these items (Fenech 2011; Mathers et al. 2007; Os and

Bjørnestad 2016). In their analysis of the item Peer interaction in the subscale Interaction, Os and

Bjørnestad (2016) found that the requirements for achieving an excellent rating were rather low. This

may account for the relatively high scores on items related to language and interactions; in other

words, this high rating may not indicate high interactional quality in Norwegian ECEC.



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Qualified teacher present in the classroom

Table 5: Independent Group T-test between grouped variable for preschool teacher present during observation vs. no preschool teacher present and ITERS-R total score and subscales

A comparison of classrooms – those without qualified teachers present and those in which at least one

teacher with a bachelor degree in ECEC was present during observations – indicates that this factor

does not influence the total ITERS-R score. However, the presence of qualified teachers was

significantly associated with differences in the Interaction subscale scores (qualified teachers present

M=4.78 SD=1.49 non-qualified staff present M=3.87 SD=1.33, t[204]=2.361 p=0.01). There were no significant

differences in the other subscales, except for Talking and Listening which differed slightly across the

groups – albeit only borderline significantly (qualified teachers present M=4.39 SD=1.37 non-qualified staff

present M=3.79 SD=1.24, t[204]= 1.871, p=0.06).

As shown in table 5, three out of four items in the subscale Interaction show significant differences

concerning qualified teachers’ presence. Only Supervision of play and learning shows no significant

differences, probably because this item emphasizes supervision connected to children’s safety and not

only educational supervision. The presence of educated staff in the classroom is also significant in

relation to Helping children to understand language. These results might indicate the importance of

educated staff especially for the core aspect of quality – interactions between staff and children and

between children (Bjørnestad et al. 2012; Dalli, White, Rockel, Duhn, Buchanan, Davidson, Ganly,

Preschool

teacher(s)

present

N=190

No preschool

teachers present

N=16

t(df)

M (SD) M(SD) Cohens’ D Effect size(r )

Interaction 4.80 (1.48) 3.75 (1.43) 2.72*(204) .72 .34

Item 25 – Supervision of play and

learning 4.38 (2.23) 3.50 (2.31) 1.51 (204) .39 .19

Item 26 – Peer interaction 4.94 (1.68) 3.75 (1.77) 2.70* (204) .69 .33

Item 27 – Staff-child interaction 5.05 (1.81) 3.94 (1.95) 2.34*(204) .59 .28

Item 28 – Discipline 4.84 (1.70) 3.81 (1.28) 2.35*(204) .68 .32

Listening and Talking

4.99 (1.57)

4.13 (1.93)

2.08*(204)

.78

.37 Item 12 – Helping children

understand language

Note: M=Mean. SD=Standard Deviation. ITERS-R variables are measured in a range from 1–7, where 1 indicates the

lowest score and 7 indicates the highest score. *p<0.05; **p<0.001



14

Kus, and Wang 2011; Melhuish and Gardiner 2017). Because of the small number of classrooms

without a qualified teacher present (n=16), the results should be interpreted with caution.

Staff-to-child ratio Comparing classrooms with a staff-to-child ratio of 1:3 or higher (e.g 1:2) with classrooms that have

ratios lower than 1:3 (see table 6) yields significant differences in quality. The differences are evident

in the total ITERS-R scores (ratio >1:3 M 3.99, SD=.79, ratio <1:3 M= 3.76 SD=.78, t(204) =2.066 p=0.04), and in

the subscales Listening and Talking (ratio >1:3 M=4.52 SD=1.34, ratio <1:3 M=4.10 SD 1.37, t(204)= 2.212

p=0.02) and Interaction (ratio >1:3 M=5.02 SD 1.45, ratio < 1:3 M=4.33 SD=1.48, t(204)=3.416, p=0.00).

TABLE 6: Independent Group T-test between grouped variable staff-to-child ratio and ITERS-R total score and subscales.

Staff-child Staff-child ratio ≥ 1:3 ratio < 1:3

N=116 N=90

M (SD) M (SD) t (df) Cohens’

D

Effect

size (r)

Total ITERS-R 3.99 (.79) 3.76 (.78) -2.06* (204) .29 .14

Space and Furnishing 3.88 (.93) 3.69 (.86) -1.57 (204) 0.22 .11

Item 4 Room arrangement 3.67 (1.51) 3.16 (1.48) -2.39* (204 .33 .17

Item 5 Display 4.28 (1.32) 3.85 (1.19) -2.40* (204) .34 .17

Interaction 5.03 (1.45) 4.32 (1.48) -3.42**(204) .48 .23

Item 25 – Supervision of play and learning 4.67 (2.16) 3.84 (2.27) -2.66* (204) .37 .18

Item 26 – Peer interaction 5.18 (1.67) 4.41 (1.68) -3.27* (204) .46 .22

Item 27 – Staff-child interaction 5.22 (1.82) 4.63 (1.83) -2.27* (204) .32 .16

Item 28 – Discipline 5.03 (1.64) 4.40 (1.70) -2.71* (204) .38 .19

Listening and Talking 4.52 (1.34) 4.10 (1.37) -2.21* (204) .31 .15

Item 12 – Helping children understand

language 5.18 (1.50) 4.59 (1.70) -2.66* (204) .37 .18



These results are in line with existing research (de Schipper, Riksen-Walraven, and Geurts 2006; Iluz,

Adi-Japha, and Klein 2016) and correspond to traditional staff-to-child ratio norms for Norwegian

ECEC (Bekkhus, Rutter, Maughan, and Borge 2011), where lower staff-child ratios are associated

with lower quality levels in toddler care (see Bjørnestad et al. 2012).



15

Group organization

Table 7: Independent Group T-test between organization and ITERS-R total score and subscales

Fixed groups

N=154

Flexible groups

N=16

M (SD) M (SD) t(df) Cohens’ D Effect size (r)

ITERS-R total 4.05 (.75) 3.44 (.78) 4,98**(204) .70 .33

Space and Furnishings 3.88 (.88) 3.56 (.93) 2.23*(204) .31 .15

Personal Care Routines 3.54 (.95) 3.34 (1.14) 1.26 (201) .18 .09

Language 4.63 (1.29) 3.47 (1.23) 5.71**(204) .80 .37

Activities 3.61 (.74) 3.14 (.76) 3.98**(203) .56 .27

Interaction 4.99 (1.41) 3.90 (1.49) 4.75**(204) .66 .32

Program Structure 4.60 (1.27) 3.64 (1.15) 4.81**(203) .68 .32



A comparison of quality in stable groups versus flexible groups shows that stable groups score higher

than flexible groups, both on the total ITERS-R score and at subscale level (table 6). An independent

t-test shows a significant difference in total ITERS-R scores between the two forms of organization

(i.e. for the stable groups M= 4.05, SD= .75, flexible groups M=3.44, SD= .78, t(204)=4.98, and

p=0.00). With the exception of the subscale Personal care routines, the differences are significant and

have high effect sizes on all subscale scores.

The distributions among the total ITERS-R scores for stable and flexible groups show that 11% of the

stable groups and only 1 flexible group (1.9%) score above 5. Almost half of the stable groups

(44.8%) and only 23.1% of the flexible groups score between 4 and 4.99. Most of the flexible groups

(46%) are placed in a range from 3 to 3.99, while 36.7% of the stable groups have scores in this range.

Only 7.5% of stable groups have scores indicating inadequacy (below 3), while the scores for 28.8 %

of the flexible groups are rated inadequate.

The most striking differences between flexible and stable groups appear in subscales connected to

interactions, language, and program structure. Norwegian and Nordic research find that children in

flexible groups experience less communication and involvement with staff (Alvestad et al. 2014;



16

Pramling Samuelsson, Williams, and Sheridan 2015; Seland 2009; Sheridan, Williams, and Pramling

Samuelsson 2014: Skalická et al. 2015; Vassenden et al. 2011).

Flexible groups also score lower on activities. Equipment for play and learning in flexible groups is

often located in various rooms far away from children’s home base. Accessibility depends on the

staff’s capacities to accompany children to different interest centres and the centres not being occupied

by other groups.

Concluding remarks The current study using ITERS-R to research the quality of Norwegian ECEC for toddlers reveals

some surprising results. First of all, the total ITERS-R score falls within the minimal quality range

(3.9). This result is in line with ITERS-R scores in other European contexts and also throughout the

rest of the world (Vermeer et al. 2016).

At subscale level, Norwegian ITERS-R scores follow the same patterns as scores from the

Netherlands, Portugal, and the UK in 2012. Personal care routines and activities scored the lowest

while Interaction scored the highest. The overall scores were at a minimal quality level (Barros and

Aguiar 2010; Helmerhorst et al. 2015; Karemaker, Mathers, and Singler 2012). However, since each

subscale contains several items that focus on different aspects of quality childcare, results on subscale

level give only a superficial impression concerning features of overall ECEC quality and have limited

value when it comes to comparing ITERS-R results and also informing the field about how to improve

those results. Different studies might report the same total scores and subscale scores, but in reality,

the qualitative aspects of childcare that underlie these scores are hidden. This is, as we see it, one

major weakness in discussions about quality care that are based upon ITERS-R measurement.

This article uses reported results at item level for its analysis of what is behind subscale scores, and

this analysis is in turn supported by information about which requirements are met at the level of

indicators. Our findings are that Norwegian toddler care faces challenges connected to a lack of

adequate materials for play and learning, inadequate hygiene, and insufficient safety supervision. Lack

of adequate materials may impact processual features like interactions between children and between

children and staff.

One aim of this article was to explore possible associations between quality as measured with ITERS-

R and selected structural features of toddler care. The study finds no differences between municipal

and privately owned centres. However, the presence of qualified teachers during observations, a higher



17

staff-to-child ratio (>1:3), and division into small and stable groups all appeared to positively impact

the quality of toddler ECEC. Classrooms with no qualified teachers present, with lower staff-to-child

ratios (<1:3), and with classrooms organized in large, flexible groups had lower ITERS-R scores.

These results to a large extent accord with results from other studies (Alvestad et al. 2014; Pramling

Samuelsson, Williams, and Sheridan 2015; Seland 2009; Sheridan, Williams, and Pramling

Samuelsson 2014; Skalická et al. 2015; Vassenden et al. 2011). The impact of these factors appears

especially strong in relation to core aspects of quality in toddler care: the interactions between staff

and children and among children. The associations between processual aspects of care (such as

interaction) and the structural features (such as ratio, presence of qualified teachers, and organizational

forms) confirm the presumption that structural aspects might have an indirect impact on processual

features (Kontos et al. 2002; Kontos and Keyes 1999; Sanders and Howes 2013). On the other hand, in

our study, educated teachers’ presence during observations is not associated with children’s safety. An

assumption based on these results might be that having qualified educators is not necessary to ensure

toddlers’ safety but nevertheless has consequences for ensuring children’s well-being, development,

and outcomes – all of which to a great degree relate to processual features of quality. Regarding

flexible organizational structures, these face some challenges regarding quality. The logistics in these

classrooms are challenging due to children’s opportunities for sensitive interactions (Eide, Winger,

Wolf, and Dahle 2017).

The quality of Norwegian ECEC is not as good as we had expected, nor is it in line with Norway’s

reputation for quality childcare. The latest results from the UK (Melhuish and Gardiner 2017) show

that they have pulled ahead of the rest of Europe with a considerable increase in ITERS-R scores over

the last few years. This might be a result of the field adjusting to ITERS-R standards after repeated

assessments of quality using this scale (Karemaker, Mathers, and Singler 2012: Mathers et al. 2007;

Mathers, Singler, and Karemaker 2012). On the other hand, repeated assessments in the Netherlands

from 1995 to 2015 with ITERS-R have coincided with decreasing ITERS-R scores (Helmerhorst et al.

2015). In order to understand what causes changes in toddler care quality in particular countries

relative to one another, it is necessary to have extensive insights into the values, policies, and practices

in those different national contexts.

Based on the results from ITERS-R in Norwegian toddler care, improvement is needed, and the

Nordic model has to be challenged further through more in-depth studies as well as monitoring the

quality over time (OECD 2015).

The results from the current study should provide useful information to practitioners and policymakers

and help inform the Norwegian debate about quality childcare for toddlers. We would like to stress the



18

importance of closely monitoring the quality of toddler care using ITERS-R. But because of the

limitations of the ITERS-R scale, future research should combine ITERS-R with other approaches to

quality research (cf. Helmerhorst et al. 2015). ITERS-R can help provide an overall picture and a point

of departure for more in-depth studies related to quality aspects.

Limitations ITERS-R represents one view of quality. It is not objective, and it has a cultural bias. Other

approaches to evaluating Norwegian toddler care might yield different results. ITERS-R provides a

broad evaluative overview of care without going into depth or details about the different aspects of

care. This limitation applies in particular to the core aspect of high quality ECEC: interactions.

Acknowledgment Thanks to research assistant Maren Meyer Hegna and PhD student Erik Eliassen for statistical

support and analysis.

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Appendix a

Table 4: Descriptive Statistics for ITERS-R Item scores

N Mean SD Min Max Skewness Kurtosis

Space and Furnishings 206 3.80 .90 1.80 6.40 .13 -.15

1. Indoor space 206 3.82 1.53 1 7 .65 .05

2. Furniture for routine care and play 206 4.53 2.06 1 7 -.33 -1.39

3. Provision for relaxation and comfort 206 3.11 1.22 1 7 1.21 1.88

4. Room arrangement 206 3.45 1.52 1 7 .23 .003

5. Display for children 206 4.10 1.28 1 7 1.01 .21

Personal Care Routines 203 3.49 1.00 1.17 6.50 .41 .11

6. Greeting/ departing 206 5.88 1.74 2 7 -1.30 .21

7. Meals/snacks 206 3.33 1.73 1 7 .81 -.28

8. Nap 203 3.51 2.42 1 7 .61 -1.44

9. Diapering/toileting 206 2.56 1.71 1 7 1.19 .24

10. Health practices 206 2.64 1.53 1 7 1.44 1.69

11. Safety practices 206 3.05 1.78 1 7 .52 -.65

Listening and Talking 206 4.34 1.37 1 7 -.24 -.72

12. Helping children understand language 206 4.92 1.61 1 7 -.52 -.38

13. Helping children use language 206 4.97 1.74 1 7 -.26 -.1.24

14. Using books 206 3.13 1.97 1 7 .50 -.99

Activities 205 3.49 .77 1.78 5.44 .18 -.20

15. Fine motor 206 3.32 1.43 1 7 .51 .18

16. Active physical play 205 4.80 1.94 1 7 -.11 - 1.29

17. Art 206 2.91 2.04 1 7 .70 -.76

18. Music and Movement 206 2.37 1.07 1 7 1.03 1.00

19. Blocks 206 2.00 1.44 1 7 1.41 1.15

20. Dramatic play 206 3.27 1.85 1 7 .36 -.90

21. Sand and water play 206 5.46 1.92 1 7 -.96 -.65

22. Nature/science 206 3.92 1.46 1 7 .82 -.17

24. Promoting acceptance of diversity 206 3.44 1.25 1 7 .65 1.34

Interaction 206 4.72 1.50 1 7 -.30 -.84

25. Supervision of play and learning 206 4.31 2.24 1 7 -.06 -1.52

26. Peer interaction 206 4.84 1.71 1 7 -.47 -.52

27. Staff-child interaction 206 4.96 1.85 1 7 -.30 -1.22

28. Discipline 206 4.76 1.69 1 7 -.27 -.80

Program Structure 205 4.34 1.31 1.67 7.00 .06 -.70

29. Schedule 206 4.61 1.62 1 7 .16 -.65

30. Free play 206 3.75 1.53 1 7 .48 .04

31. Group play activities 205 4.70 2.16 1 7 -.20 -1.52

ITERS-R total score 206 3.89 .80 1.64 5.9 -.11 -.07

Excluded items:

32. Provisions for children with disabilities 24 6.75 .74 4 7 -.31 9.37

23. Use of TV, video, and /or computer 22 4.59 2.01 1 7 -.34 -1.27

Note: this table depicts the summary of each subscale of the ITERS-R followed by the items in each scale and the total score.



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Quality in Norwegian childcare for toddlers using ITERS-R...Quality in Norwegian childcare for...

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