The use of the Quality Rating and Improvement System (QRIS) to improve early childhood education program quality is based in part on assumptions that the quality of programs can be measured and that quality ratings are associated with meaningful differences in learning outcomes for children. This report reviews all of the state QRIS validation studies that examined associations between individual rating elements and child outcomes as well as other research that exists on four elements of the California QRIS, referred to as Quality Counts California: (1) teacher qualifications; (2) program environment; (3) teacher-child interactions; and (4) child-to-teacher ratio and group size. The review indicates that the current elements in Quality Counts California have weak and inconsistent associations with child outcomes. The problem is not necessarily with the dimensions measured but with how they are measured and with how points are allocated. The report recommends: (1) developing a program observation measure that is better aligned to desirable child outcomes, including foundational academic skills; (2) creating a measure of teacher qualifications that includes the nature and extent of courses in early childhood education (ECE); (3) differentiating between programs that serve children of different ages; and (4) considering additional ratings related to the quality of work environment and pay. An examination of cutoff scores in rating rubrics and the use of more comprehensive measures of child outcomes in validation studies are also recommended.