Featuring a new spiral binding, the updated ITERS-R offers more practical assistance in the form of additional notes for clarification and an Expanded Score Sheet, which incorporates notes and tables to assist in scoring. However, the items and indicators remain the same as in the original ITERS-R. Designed for use in center-based child care programs for infants and toddlers up to 30 months of age, the ITERS-R can be used by program directors for supervision and program improvement, by teaching staff for monitoring, and in teacher training programs. The established reliability and validity of the scale make it particularly useful for research and program evaluation.