First, calculate the change in QRIS Scores, by subtracting the previous QRIS score from the current one. Scores that are positive indicate an increase while scores that are negative indicate a decrease. Those program sites that indicate a “Yes” for the data element Use of Assessment. Program sites can be separated into four groups: those that did not and do not use child assessment; those that did not but now do use child assessment; those that did and now do not; and those that used child assessment at both time points. Compare the change in ratings for those that have never used assessment and those that started using assessment to see if the latter group showed greater positive growth in their quality scores.