A Team Effort
As a full-time pharmacist for a hospital, Jennifer Trevino needed dependable child care for her young children. Her son has a genetic variance, autism, global developmental delay and other health concerns, although he didn’t have all these diagnoses when he started attending child care. As they began seeking appointments, Trevino kept her son’s child care facility informed of any updates.
Quality child care supports a child’s development, and any positive child care program represents a collaboration among center staff and families. When a child has healthcare, behavioral or other needs, it’s even more important to have that connection.
FINDING THE RIGHT FIT
Many parents of children with special needs share frustrating stories about their child care experiences. Parents say they’ve been told that a center isn’t equipped to handle their child’s needs. Or they try a center and are frequently called to pick up their child due to behavior concerns.
Trevino’s son had a positive experience at his first child care center. She changed to a different site when he attended developmental preschool because the school district could provide bus service to that center for him to attend the rest of the day. Unfortunately, this experience was negative, and Trevino said she and her husband were called into a meeting with the site director. “They made us feel like if our child didn’t fit their mold, he was out of there,” Trevino said.
They tried other locations including a center specifically advertised as caring for children with special needs but didn’t find a good fit right away. Ultimately, a center receiving services from Quality First (https://www.qualityfirstaz.com) provided the environment her family needed. This program sends child development specialists to observe children’s behaviors and coach child care staff.
They were also in the process of getting her son diagnosed with autism. “The teacher went above and beyond, taking notes for me to have for anyone involved in assessing him,” Trevino said. She also continued to share information with the center, and they allowed her son’s behavior coach to accompany him to the child care program.
LEGAL CONSIDERATIONS
The Americans with Disabilities Act (ADA) applies to child care centers. According to a FAQ page on ADA.gov (https://www.ada.gov/resources/child-care-centers), privately run child care centers must comply with Title III of the ADA, unless they are run by a religious entity such as a church or synagogue. Centers run by government agencies must comply with Title III.
Title III includes verbiage that centers can’t exclude children with disabilities unless “their presence would pose a direct threat to the health and safety of others or require a fundamental alteration of the program.”
While parents might have the law on their side, it can be hard to know how hard to push. But parents can ask questions and see whether a center’s hesitance to admit a child is related to assumptions or reality.
“Decisions to deny a child can’t be based on a disability, diagnosis or on an assumption alone,” said JJ Rico, chief executive officer for Disability Rights Arizona (https://disabilityrightsaz.org). “They can’t have blanket exclusions based on assumptions or stereotypes,” he noted. “For example, they can’t exclude all kids with disabilities because they assume they are aggressive or violent or say they can’t assist kids who need to take medication.”
He suggests that parents ask more questions about why a center thinks a child might not be a good fit and share information about environments where their child does well and how a center can support their child.
Rico acknowledges that while child care centers are expected to follow ADA, parents might not want to fight, especially if they don’t feel a center has the services their child needs. Parents can continue to question an enrollment decision until they hear “no,” he added, and then they can look elsewhere. They could also consider filing complaints with the Department of Justice (https://civilrights.justice.gov/report) or the Arizona Attorney General’s Office, Civil Rights Section (https://www.azag.gov/civil-rights).
AVAILABLE ASSISTANCE
State programs can provide assurance to parents of children with special needs who need child care while supporting staff at these programs. Quality First, a program of First Things First (https://www.firstthingsfirst.org), offers coaching and professional development for child care staff. They can also provide specialized assistance in supporting children with special needs in child care settings. Parents can use the Quality First search tool (https://www.firstthingsfirst.org/quality-first-search) to find participating programs around the state.
The Smart Support (https://www.swhd.org/training/smart-support) and AZ STEPS ((https://www.swhd.org/expulsion) programs also support families and child care centers statewide with preventing expulsion, including for children with special needs. AZ STEPS, a Department of Economic Security (DES) program, provides support to families and DES-contracted child care providers to prevent disruption of care by providing on-site or virtual assistance. If developmental concerns are identified, AZ STEPS supports an inclusive environment. Smart Support partners with child care centers throughout the state. Consultants work with child care staff and families on behavioral health and other concerns.
“We’ll ask providers questions about their understanding of challenges, what’s worked or what have they tried before,” said Cindy Matcha, Smart Support/AZ STEPS supervisor. “We want to help families and providers come up with action plans. We’ll suggest strategies and test our theories about behavior.” This process will often include performing Functional Behavior Assessments and using Positive Behavior Support to create Behavior Improvement Plans.
Parents can ask if their child care center receives services from Smart Support. Or if their child attends a child care program that services children authorized for Child Care Assistance through DES, parents can request support for AZ STEPS through the Child Care Resource and Referral website (https://www.azccrr.com/child-care-resources–referral.html). Support is available at these programs if their child attends a DES child care, whether or not the child qualifies for Child Care Assistance. The request for support can be submitted by anyone who needs support from AZ STEPS, including childcare providers, families and other state agencies.
Parents can find suggestions and checklists for finding quality childcare, along with information about financial assistance for care, on the Child Care Resource and Referral site.
The Birth to Five Helpline also assists families in their childcare search. Team members can do legwork to help parents locate appropriate sites, notes Maria Lopez, senior program manager with Birth to Five Helpline.
“The relationship piece is critical,” Lopez added. “Parents want to know that their child will be welcomed, and the center will stay in touch and check in. It’s important to be an advocate for your child, but also to trust your own instincts. If something doesn’t feel right, first talk openly with the center staff and/or director. If things don’t get better, begin exploring new options.”
OTHER SUPPORTIVE PROGRAMS
Home visitation provides another option to help children and their families feel ready for child care. Parents will often stumble across these programs while searching for options after their children didn’t qualify for services through the Arizona Early Intervention Program (AzEIP) or their local developmental preschool, said Tina Oluyi, program director of Parents as Teachers at Child and Family Resources.
Or parents might have children who aren’t talking as much as expected and are concerned about sending them to child care, she added. Home visits can provide information and activities to help a child’s development until the family is ready for child care. Home visiting programs are also supported by First Things First, and parents can search for programs throughout the state on the Strong Families AZ website (https://strongfamiliesaz.com/programs/).
Oluyi believes that many parents are reluctant to bring up developmental concerns when they look for child care. “Have those discussions on day one when touring a center and ask if they have staff who can handle children with special needs,” she suggested. She also encourages families to use First Things First to find child care programs with Smart Support.
The Inclusion Program (https://www.swhd.org/training/inclusion-program/) is designed to help childcare programs support children aged birth to 5 with developmental delays or disabilities in classrooms in parts of Maricopa and Yuma counties. Participating centers receive support in working with all children, including children with special needs.
Kathryn Moon, program manager with the Inclusion Program, described a site where an inclusion coach came alongside a newer teacher who struggled with behavior management in the classroom. The coach identified 6-7 children with developmental concerns and aggressive behavior. Some children had been expelled, and others were frequently sent home. The coach supported the teacher in creating consistent schedules, routines and visual aids for the students to better understand the sequence of each day.
After a few months, children in the class were no longer being expelled or sent to the site office. “Many times, we’re having to pick apart the situation to see if it’s a developmental need or a product of the environment,” Moon added. In this case, environmental support met the children’s needs.
Some sites receive inclusion services on a regular basis while other centers come in and out of the Inclusion Program as needed. Parents can contact the Inclusion Program to see if there’s a participating site in their region. They can also ask a site if they would opt to participate in the program.
One common challenge among parents and childcare sites are children with developmental delays who aren’t yet toilet trained. “We can provide coaching to the staff on how to make this work if they don’t have diapering facilities in the classroom,” Moon said. Child care sites are frequently concerned about their licensing rules related to diapering and toileting.
“If a child has a special need, there’s no reason they can’t be in the classroom,” Moon added. “If the program obtains documentation of a child’s delay or disability, they can work with their licensor to ensure that they’ll be in compliance.” Centers can also build support for bathroom time into existing transition times during a day. These are examples of how Inclusion Coaches can provide support to child care programs to include children with special needs.
Once children attend school full-time, parents still need care after school and during school breaks. The Arizona Center for Afterschool Excellence https://azafterschool.org) provides an afterschool program directory and a checklist of considerations.
PARENT STORIES
Parents who’ve had experience with childcare centers for their children with special needs encourage other parents to trust their gut.
Crystal Garcia has a son with Down syndrome and also had frustrating experiences with child care centers. When he was 2 years old and not yet walking, a center told her they couldn’t support him.
She continued looking and found an in-home child care provider. Right away, the provider asked questions about how to support her son and he immediately seemed to feel at home. While evaluating this provider, Garcia checked references and watched interactions among the provider and the site’s parents and children at drop-off and pickup. “That was reassuring as well,” she added.
Garcia also encourages parents to be up-front about a child’s disabilities or challenges. “If they aren’t reassuring you that your child is in good hands, or they aren’t asking how they can help your child, it’s not the place to go,” she said. “They should be encouraging you.”