Eight programs in each State were evaluated by interviews conducted with 175 persons involved with the programs. Interviewees were administrators, middle managers, line staff, and client representatives; 100 were professionals in child care delivery services. Accountability measures fit into three basic categories: self-established by the provider, those imposed by the supervising agency, and those created statutorily and presided over by an agency other than the funding agency. Providers relied largely on informal mechanisms. Agency supervision was composed of internal systems for program and contract review, and the investigation of abuse allegations. State watchdog agencies rigorously investigated and pursued allegations of abuse and conducted sporadic reviews of provider programs. Private accountability efforts are therefore totally dependent on the program administrator, while State agency efforts seem to escalate simple grievances into allegations of abuse. These latter efforts are conclusions are that accountability systems must be more carefully planned and systematic, providers need to develop complaint procedures incorporating both formal and informal review processes; clients need greater access to mechanisms for monitoring institutional abuse; and State agencies must improve their supervision of providers with regular programmatic reviews, review process coordination, and client surveys. Four footnotes, program descriptions, and the interview protocols are provided. (Author abstract modified)