Last week, Whole Child’s program and evaluation teams and our partners at Duke University rolled up our sleeves for a five-day working session on WCI-QCUALS, our tool for measuring quality of care in limited-resource childcare centers. The team spent the week pulling apart the elements of the tool and analyzing each of them for user-friendliness. User-friendless is especially important for something designed to be used by highly burdened staff and supervisors of early childcare and development and residential childcare centers in some of the world’s most resource-deprived places.

Since our founding nearly 15 years ago, Whole Child has believed passionately that one of the key obstacles to the improvement of quality of childcare is how to measure it. We are concerned that as interest in improving quality of care continues to grow, the focus in investment will remain on buildings and materials — when science tells us the most important factor for children’s emotional well-being is the quality of the relationships in their lives. From the beginning, this factor proved difficult to measure, but we were faced with another crucial challenge as well: the predominance of tools designed for care centers in developed nations to measure centers in under-developed countries.

(Factors that might “fail” a center in the United States, such as a dirt floor or unreliable electricity, are far less important in a neighborhood where these things are commonplace. It is important to focus on things like the caregiver’s ability to connect with a child while changing her diaper — which is of primary importance no matter where you are.)

In 2012, we started working with the Center for Health Policy and Inequalities Research (CHPIR) at Duke University’s Global Health Institute, which shared our passion for measurement and the importance of relationship in children’s long-term well-being. We worked together to fine-tune the tool and turn it into a smartphone/tablet app. Together, in 2014, we piloted use of the tool on a nationwide scale, measuring 213 centers in the “National Evaluation of Quality of Childcare in El Salvador” as part of our project partially funded by the Inter-American Development Bank, “Improving the Quality of Care in Early Childhood.”

Last week’s arrival in San Salvador marked the beginning of the second phase of our development of the tool, which we look forward to using as a key measurement tool in our USAID project. It is designed for use in a variety of settings, including early child care and development (ECCD) centers, residential care centers, centers for previously trafficked children, and many more. When completed, there will be multiple versions, including one that centers can use for self-assessment, and one for governments to monitor centers they operate and supervise. Crucially, we have always intended to make the tool free to use, as the cost of measurement tools is very often a prohibitive factor in situations where they are most important.

We were deeply grateful to have our faithful friends at Duke working alongside our own team — led by CHPIR Director Kate Whetten, Research Associate Hy Huynh, and Research Analyst Andrew Weinhold. The team brings invaluable experience assessing quality of care through their numerous NIH-funded studies.

Pictured: (Top) Whole Child and Duke staff working together on QCUALS. (Bottom) Longtime collaborators Kate Whetten and Karen Spencer, respectively Director, Center for Health Policy and Inequalities Research, Duke University; Whole Child Founder & CEO.