Decades of research has documented the negative effects of physical punishment, including spanking (Heilmann et al., 2021). Since 1998, the American Academy of Pediatrics (AAP) has endorsed the use of time out from positive reinforcement (TO) as an alternative to corporal punishment (Sege et al., 2018). Despite urging at the federal level (Cardona, 2023) as of 2024, 23 states continue to allow corporal punishment in public schools. However, while K-12 systems allow corporal punishment, it is an allowed form of discipline in only one state’s center-based child care licensing regulations (National Center on Early Childhood Quality Assurance [NCECQA], 2020a).

State Level Child Care Regulations

Child care is licensed at the state level (Hotz & Xiao, 2011), with state specific minimum standards under which programs may operate. Previous research has demonstrated that child care licensing regulations influence all aspects of care programs provided (Gallagher et al., 1999). Research has shown a general relationship between state level child care licensing regulations and differential levels of quality across states (Apple, 2006; Cost, Quality, and Child Outcomes Study Team, 1995; Hotz & Xiao, 2011; Rigby et al., 2007, Raikes, et al., 2005). As elements of quality, the field of health and safety includes research on state licensing regulatory compliance with best practices (Addiss et al., 1994). For instance, researchers have examined the alignment of state child care licensing regulations with evidence-based practice on promoting safe sleep (Benjamin Neelon et al., 2014; Moon et al., 2001) breast feeding (Benjamin Neelon et al., 2015); physical activity (Duffey et al., 2014), and obesity prevention (Kaphingst & Story, 2008). The state regulatory differences can also be understood as regional differences. For example, Buell et al., (2024), found regional differences in expulsion and suspension ECE regulations. Duffey et al. (2014) found that regulations on physical activity were more prevalent in the North compared to the Midwest. Benjamin Neelon et al., (2014, 2015) discovered regional differences in regulations regarding sleep practices and breastfeeding support in childcare.

In most states, regulated care is categorized into two types: center-based and home based. The federal government distinguishes between two types of home-based programs: small/regular family childcare homes (FCCHs), often limited to serving six children, and large/group child care homes (GCCHs), typically permitted to care for more than six children (NCECQA, 2020b, 2020c). In 2022 there were over 93,000 Early Care and Education (ECE) centers and almost 95,000 regulated Home-Based Care (HBC) programs (Child Care Aware, n.d). Between the sectors of center and home-based care there are differences in educational requirements for staff (McLean et al., 2021). For instance, eight states have no educational requirements and another 11 require a high school diploma or GED for center-based child care staff, as opposed to home-based child care where 20 states have no educational requirements and another 10 require a high school diploma or GED. There are also differences between sectors in the need for discipline policies (NCECQA, 2020a, 2020b, 2020c). For instance, “supervised separation from the group” (TO), is allowed in 23 group-home, 25 family home, and 28 center based state child care regulations (NCECQA, 2020c, 2020b, 2020a).

As a form of exclusionary discipline, TO should be used judiciously, and with fidelity (Mclean et al., 2023). Research has revealed that in ECE programs, exclusionary discipline, including TO, is often used (Zinsser, 2022; Gansen, 2021), but can be applied unequally based on factors such as race, gender, ability status, socioeconomic status, and exposure to adverse childhood experiences (Gansen, 2021; Gilliam, 2008; Jackson & Testa, 2020; Meek & Gilliam, 2016; Zeng et al., 2019, 2020). With approximately 11.8 million U.S. children 5 years old and younger participating in non-parental care (Committee on Economic Development [CED], 2019), understanding how TO is regulated in state-level child care policies provides a potential mechanism to counter inappropriate exclusions.

Research on TO

TO is a well-known discipline and teaching strategy (Lieneman & McNeil, 2023) based on behaviorist principles (Azrin, 1961; Ferster, 1957). Initially employed with animals (Ferster, 1958), TO has also proven effective in changing human behaviors (Baer, 1961; Clark et al., 1973; Readdick & Chapman, 2000; Wolf et al., 1963). For an in-depth review of TO please see Brantner and Doherty, (1983), Bagwell et al., (2022) and Lieneman and McNeil (2023). The first extant evidence of the use of TO with children is an experiment where TO was employed to teach children to press a bar in order to watch cartoons (Baer, 1961). Later, Constance Hanf included TO as an important component of her behavioral parent training intervention (Kaehler et al., 2016). For TO to work with children, the expectation is that the child is experiencing a reinforcing “time in” environment (e.g. interesting activities, positive adult child interactions, etc.), but, as a consequence of misbehavior, a TO from the rewarding environment is imposed (Herrnstein, 1990), reducing target misbehaviors (Leitenberg, 1965).

Since its emergence, TO has become one of the most widely used and recognized behavioral interventions (Mclean et al., 2023; Ryan et al., 2007). The American Psychological Association (APA) includes TO in their information on effective parenting strategies (Novotney, 2012), and the Centers for Disease Control and Prevention (CDC) dedicates a section to the use of TO in their “Essentials for Parenting Toddlers and Preschoolers” website (CDC, 2019). TO is also a component of several well-researched parenting programs, including the Incredible Years (Webster-Stratton, 2006), Triple P—Positive Parenting Program (Sanders, 1999), and Parent–Child Interaction Therapy (PCIT: McNeil & Hembree-Kigin, 2010). In a meta-analysis of the various components of the above referenced parenting programs, at the individual element level, TO was found to be a key element of the program’s effectiveness (Larzelere et al., 2020; Wyatt Kaminski et al., 2008).

While TO appears simple, in reality “TO is actually quite complex, consisting of several steps which must be carried out with fidelity” (Drayton et al., 2017, p 92). McLean et al. (2023) refer to these as ‘evidence-based guidelines’ or ‘parameters’.

TO Parameters

Due to its extensive history, a significant body of research has emerged examining the parameters of the TO protocol (Corralejo et al., 2018b; Danforth, 1998; Drayton et al., 2014; Lieneman & McNeil, 2023; Woodfield et al., 2022). Researchers have generally assessed eight elements in terms of their impact on the effectiveness of TO (Corralejo et al., 2018a; MacDonough & Forehand, 1973): Location, supervision, schedule, duration, contingent release, warning, administration and signal. Of these, only signal has shown no relationship to the effectiveness of TO. Table 1 provides details on the research base related to each of the other seven elements.

Table 1 Research base for elements of TO
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Guidance for the use of TO

Given the number of elements in the TO protocol and the level of specificity required for their application, it is not surprising that the research on the use of TO by parents and teachers often fails to meet fidelity to the TO process requirements (Drabman & Jarvine, 1977; Riley et al., 2017; Williford et al., 2023). For instance, research by Foreman et al. (2021), found even in the presence of behavioral intervention plans, ECE staff did not apply TO with integrity. Likewise, Gansen (2021) found that in ECE programs, TO was misapplied to all children, and differentially applied to children of color and low-income children. Examples of misapplication include the description of a child being placed in TO for over an hour.

While licensing regulations and accreditation standards may not prevent the inappropriate use of TO (Foreman et al., 2021; Gansen, 2021; Giordano et al., 2022), they serve as a basis for programmatic operations. Group sizes and ratios, level of supervision and support as well as low levels of education all influence discipline strategies in ECE programs (U.S. Department of Health and Human Services & U.S. Department of Education, 2016). Considering that exclusionary discipline can have significant implications for children (Prochner & Hwang, 2008; Readdick & Chapman, 2000) and recognizing that much of the information in popular and even expert discourse regarding the necessary elements of TO is inaccurate (Drayton et al., 2014), it is crucial to assess state childcare regulations pertaining to TO in order to mitigate inappropriate TO guidance. While Buell et al., (2022) demonstrated that TO is found in 32 states’ center-based child care licensing regulations, they did not explore the component included in the TO policies. Furthermore, this is the first research addressing TO policies in home-based child care settings. In general, research on home-based child care policy is lacking (Porter et al., 2010), and this study helps to address this gap.

Research Questions

  1. 1.

    Are there regional variations in the number of states that address TO within their center-based and home-based child care licensing regulations?

  2. 2.

    Among the states with regulations on TO, does the regulatory language include the research-based parameters of TO? If so, is the guidance on the parameter consistent with the evidence-base on effectiveness of the parameter?

Methods

This is a census of child care licensing regulations across all 50 states and the District of Columbia (DC).Footnote 1 All 51 states have center-based child care licensing regulations. The landscape for HBC is more complex. The federal government defines two types of home-based care (NCECQA, 2020a, 2020b). The first type is FCCHs, settings where one person cares for children in a residence that is not the child’s home. According to this definition, seven states do not license FCCH: Arizona, Idaho, Indiana, Louisiana, New Jersey, Ohio, and South Dakota. The second type of home-based care is GCCHs. These programs can be in homes but are also located in nonresidential settings with more than one caregiver. Based on this definition, Arizona, Idaho, Indiana, and Ohio regulate GCCH. Thus, only three states – Louisiana, New Jersey, and South Dakota – do not have regulations that address at least one type of home-based care. We included the data in our analysis in either type of home-based setting. Lastly, ten states use the same set of regulations across the center and home-based settings.

Analysis

Using qualitative content analysis methods (Krippendorff, 2018), we determined the “manifest content” in the policy documents (Berelson, 1952). We initiated our document search on the Office of Child Care’s National Database of Child Care Licensing Regulations website (https://childcareta.acf.hhs.gov/licensing), where we found links to each state’s child care licensing regulations websites. We identified the center and home-based licensing regulations, policies, and guidance manuals on the state web pages. To ensure that we obtained the most up-to-date and comprehensive set of licensing documents, we conducted a Google search using the query “[state] licensing regulations” to locate the latest version of the licensing regulations. Once obtained, we downloaded the documents into our database and performed a word search within each document to identify sections pertaining to “guidance”, “discipline”, “behavior management”, “child management”, or “child supervision”. During this process, we discovered that four states – Connecticut, Hawaii, Idaho, and Kentucky – do not have a discipline/guidance/behavior management section in their licensing standards. Consequently, we expanded our document search to include language addressing TO, using terms such as “timeout”, “time-out”, “time out”, and “separat-”. This search led to the discovery that Connecticut does address TO in its licensing regulations. Once located, we extracted the relevant sections of the regulations that discussed TO or similar terms and recorded them in a database, which we then used to code the regulations based on the eight elements of TO discussed earlier. Table 2 provides the elements of TO, their definitions, the indicators we created based on those definitions, and the corresponding codes for each indicator.

Table 2 Coding for the eight elements of TO
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To distinguish policies addressing TO from isolation, we relied on contextual clues. Policy language concerning isolation was identified within states’ lists of prohibited discipline strategies. In contrast, regulations addressing TO were formulated affirmatively, outlining what actions could be taken to exclude a child based on a behavioral infraction. Frequently, these two concepts were discussed together. For example, Mississippi’s center-based regulations state:

Time-Out: “Time-out” that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, taking into account the child’s developmental stage and the usefulness of “time-out” for the particular child. “Time-out” means that the child is given time away from an activity which involved inappropriate behavior. Isolation from a

caregiver is not acceptable.

All the documents were initially coded by at least one researcher, and 50% of all the documents underwent double coding to ensure that no policy language was overlooked. In cases where the policy language was unclear, or disagreements arose between the coders, they were resolved through discussion and mutual agreement.

We assessed regional differences by grouping the states into four regions based on the US Census, following the categorization used by the National Survey of Early Care and Education Project Team (2022).

Results

Question 1

Are there regional variations in the number of states with policies addressing TO in their center and home-based child care licensing regulations?

Out of the 51 states, 32 states have regulations on TO in their center-based child care licensing regulations. Among these 32 states, 28 also regulate TO in either FCCHs or GCCHs. Among the four states that regulate TO in their center-based programs but not in their home-based programs, Louisiana and New Jersey do not require mandatory licensing for either FCCH or GCCH. The remaining two states that do not include TO regulations in home-based settings but address them in center-based settings are Indiana and South Carolina.

While TO is the most used term, other terms used to describe the practice of removing children from positively reinforcing experiences for disciplinary purposes include.

“separation”, “isolation”, and “removal”. Table 3 provides a list of these terms organized by region and state.

Table 3 Terminology for TO by State and Region
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Regionally, in the Midwest, TO regulations are present in 81.82% of center-based child care regulatory standards and 72.73% of home-based regulatory standards. Conversely, the West has the lowest percentage of states regulating TO.

Definitions

The licensing documents in five states include definitions of TO. These are listed in Table 4.

Table 4 States Definitions of TO or its Equivalent
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Question 2

If the states’ childcare regulations include policy addressing the use of TO, is the regulatory language consistent with the research-based elements of the established TO protocol?

Figure 1 presents the state child care licensing regulations on TO coded according to their inclusion of evidence-based parameters.

Fig. 1
figure 1

State and regional TO parameters in center-based and home-based TO policies

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The element specified most frequently for TO was location/supervision. In center-based regulations, 19 states specified removal from peers, activities, or both, while 15 states with home-based regulations specified location in this manner. Two states, WY and MN, require children in TO to remain in the classroom, with WY further mandating that they stay with the group. Connected to location, in five states where the regulatory language specifies that a child is removed from the group, supervision is not explicitly mentioned, suggesting that the child could be isolated during the TO.

The second most frequently specified element among states regulating TO is duration. Within center-based regulations, 71% of states mention TO duration, while in home-based regulations, it is mentioned in 74% of the states, typically referring to the maximum time allowed. Table 5 outlines specific details on how states regulate TO duration.

Table 5 Duration by state and type of care
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Additionally, seven states specify behavioral contingent release in center-based regulations, and five states do so in home-based regulations.

Discussion

In the current study, we find TO included as a behavior management strategy in over half of the states’ child care licensing regulations. Regionally, the South tends to have a higher proportion of regulations concerning TO, while the West has a lower proportion. In most states, if TO is regulated in center-based programs, it is also regulated in home-based programs, however, regulations are more common. Only five states define TO, and these definitions diverge from the research-based definition of TO. In particular, Louisiana’s definition of TO is confusing with its assertion that by experiencing a period of calming a child’s inappropriate behavior will be discouraged. Likewise, Indiana’s guidance that the child participates in an “Out of group” activity, with adult supervision could actually be a reinforcing experience for a child.

For research question two, we find that in most cases states if states have TO policy language, it includes only three research-based parameters: location, supervision and duration. While these parameters are included the guidance is often not consistent with the research evidence.

Comparing Parameters with the Evidence Base

Time-in is everything that happens in the child’s environment, and that these experiences are enjoyable and reinforcing as a matter of course. This is a critical dimension because the general experience of time-in must be positively reinforcing if TO is to work. Only one state’s center-based policies stipulate that the location should be less reinforcing than the “time-in” setting. Likewise, in one state regulations instruct an adult to sit with the child and engage in conversation during a TO. This approach could create a situation that may be more reinforcing than the one from which the child is being removed, thereby serving as a positive reinforcer, rather than a TO from reinforcement. On the other hand, it is worth noting that legal challenges have been raised against the use of seclusion, confinement, and isolation TO (Bon & Zirkel, 2014). Twenty-seven states include specifications regarding the supervision of a TO. Among them, 25 states require an adult to see the child, while one state specifies that the adult needs to be able to hear the child.

Six states employed contingent release for TO as a part of the regulated procedure. In five states, the child must either regain self-control and in one state they must be ready to play with others. While contingent release has the potential to shorten a TO, without limits it can make the time spent in TO excessively long. In five of the six states with contingent release, TO can go longer than six minutes, and in two of the states it can go on indefinitely.

Further, seventeen states (47%) provide specific durations for TO beyond those connected to contingent release. Previous research indicates that very short durations of TO (30–60 s) are effective regardless of age. However, in 12 states, TO regulations specify that the duration should be based on the child’s age, with each year equating to a certain number of minutes. Although using years of age as the length of TO does not typically result in excessive harm, other approaches to specifying duration raise concerns. In six states, the regulatory language is vague, using terms such as “developmentally appropriate lengths of time”. Given the lack of education and training in the ECE workforce (Mayfield & Cho, 2022), it is likely that the interpretation of what constitutes an “appropriate” amount of time will vary. The states’ lack of evidence-based guidance on the duration of a TO is an area where policies could be strengthened by aligning with the research base.

Lastly, research evidence clearly shows that implementing a consistent schedule of TO is the most effective approach for eliminating misbehaviors that warrant its use. However, several states recommend that TO should only be employed as a last resort after exhausting all other strategies.

Limitations

This is a study of policy; therefore, we cannot make causal inferences on the impact that policy language has on practice. A difficulty in testing the relationship between any type of exclusionary discipline and policy is the lack of data that would be needed to test this relationship. Unfortunately, only one state, Minnesota, requires that a report be issued.

Without data on the use of TO, there is no way to measure the effectiveness of these policies.

Further, while policy language may be one factor in explaining differences in state and regional uses of exclusionary discipline, there are many other factors that will also influence practice. TO is just one behavior management strategy, and as stated is best used within the context of an overall behavior management plan that includes other elements such as those included in the NAEYC accreditation standards (2019), and the Divinsion of Early Childhood’s Recommended Practices (Division of Early Childhood, 2014). Future research studies could evaluate state level child care licensing regulations based on these elements.

Policy Considerations

Children from low-income and marginalized communities already face limited access to the advantages of high-quality ECE, and the implementation of exclusionary discipline methods like TO disproportionately affects these same children, exacerbating educational inequalities (Gilliam et al., 2016; Meek et al., 2020).

With minimal preservice educational requirements, which generally do not mandate college-level coursework in child development or ECE, the ECE workforce can be considered a lay workforce (Mayfield & Cho, 2022). In research on the general population, the evidence-based guidelines comprising effective TO are not understood (McLean et al., 2023; Riley et al., 2017). However, creating truly evidence-based regulations will be exceedingly challenging due to the abundance of misinformation available on this subject. Everett et al. (2010) found that most published peer-reviewed research on TO interventions with families did not include all the essential components of TO. Likewise, the practice of using years of age to determine the duration of TO aligns with guidance provided by the AAP (Sege et al., 2018), the CDC (2019), and Caring for Our Children (AAP, 2019). Some argue that TO is theoretically inconsistent with developmentally appropriate practices (Lapointe, 2016). However, when implemented as part of a well-designed behavior management system, TO can be highly effective. TO is recognized as an effective strategy for behavior change, allowing children to fully engage in ECE programs. Indeed, Zero to Three counters the narrative that TO is harmful to children by encouraging its judicious and appropriate use and offers evidence-based guidance on using TO (Parlakian, 2016). However, this effectiveness can only be achieved when TO is used carefully and in accordance with evidence-based practices. Currently, child care licensing regulations do not adequately support the appropriate and accurate utilization of TO to promote positive behaviors in ECE settings.

Policy Suggestions

As policy developers seek to create better TO policies within their child care regulations, there are a few elements to consider. Firstly, policies should be clear and leave little room for variances in interpretation as unclear policy can be interpreted differently by different individuals (Ball, 1993). For instance, most adults do not know the true meaning of the term “time out”, therefore, using the longer term “time out from positive reinforcement” may help in this regard. Second, policy language should be specific and unambiguous. For instance, the phrasing that TO should be “appropriate for the child’s age and circumstances” or only be used if “the child has the ability to learn from it” is not clear and leaves much for the ECE provider to interpret (Ball et al., 2011). Third, it should include guidance consistent with the evidence base. For instance, the mythical one minute per year of age should be strongly discouraged, and providers should be instructed to start with a TO of 10 s, and if necessary, go up from there. However, there are elements of appropriate practice that are not included in the research cannon on TO. For instance, a common complaint regarding TO is that it does not teach children what to do.

Conclusion

Despite its widespread use, and effectiveness, TO is frequently misunderstood and misapplied (Drayton et al., 2014; Gansen, 2021; McLean et al., 2023; Riley et al., 2017). Likewise, children in ECE programs find TO objectionable (Wiltz & Klein, 2001) or ineffective (Ceglowski & Bacigalupa, 2007). While there are critics of TO in the popular press (Lapointe, 2016; Siegel & Bryson, 2014), and it is clear that TO does not teach appropriate behaviors (Readdick & Chapman, 2000), TO is generally regarded as an effective behavior management strategy to prevent problematic behaviors when implemented faithfully within the context of a comprehensive guidance approach (Dadds & Tully, 2019; Dunlap et al., 2004; Morawska & Sanders, 2011; Taylor et al., 2013; Wolf et al., 2006; Yell, 1994). Policies can assist with appropriate implementation.