The Upper Valley of New Hampshire (Grafton and Sullivan Counties) and Vermont (Orange and Windsor Counties) is a cohesive region in many ways: for instance, workers flow across state borders and the demographic makeup of the area is similar across states. Yet the early childhood context of the Upper Valley has some sharp distinctions across state borders, many of which are tied to state policy decisions over time. This brief explores how state-level decisions manifest in the child care sector, contextualizing findings within the specific context of the Upper Valley as an interstate region. (author abstract)