Who's Challenged? Children with Special Needs, or their Caregivers?

Johnny's parents call you about enrolling him in your program. Johnny has severe physical limitations and is mentally challenged. Your initial reaction may be 'No, I cannot handle a child who needs extra attention. I am not trained to care for a child like that. I cannot expose the rest of my children to someone so different.' But you say to the parents, 'Let me think about it and I will get back to you.' After doing some research and visiting more with the parents, you decide that you can handle Johnny in your program. Now what do you do?

Part One of this two-part series (Healthy Childcare April-May 2000), focused on the feelings a childcare provider may have when encountering a new and uncomfortable situation along with the benefits to enrolled children when a child with a disability joins the program. Part Two explores what may happen in your childcare facility when you say 'yes' to Johnny's admittance to your program.

According to the Americans with Disabilities Act (ADA), all childcare facilities (except licensing-exempt programs) are required to accept children regardless of their disability, if it is an appropriate placement for the child. Ideally, parents of children with disabilities should have many options. But what does it mean to you? Will you have to make major changes in your facility and program? You have numerous questions. So, where do you start?

The ADA states that public accommodations, including childcare programs, must make reasonable modifications in policies, practices, and procedures in order to oblige individuals with disabilities unless the modifications would fundamentally alter the services you provide. In that light, it is necessary for you to consider the individual child and assess whether his or her needs can be met within your existing programming. You can do this by talking with the parents and the other professionals who work with the child on a regular basis to get a sense of the child's abilities, limitations, and special needs. Although you want to try to include all children, a childcare program is not required to accept a child whose presence or care would unquestionably change the nature of that childcare program.

Once you accept a child with special needs into your care, expect that some changes will be needed, such as:

• Revision of policies and procedures (for instance, you may have to modify your practices should you accept an older child who still requires diapers);
• Curriculum adaptations;
• Removal of physical barriers such as installing ramps or handrails;
• Provision of additional staff training (everyone needs to be trained in basic care; some may need additional training specific to the disability or medical condition of the child in their care);
• Provision of certain adaptive equipment or therapeutic interventions.

You may want to look at your facility to see what changes might be necessary before enrolling a child with disabilities. The following are a few ideas to make your facility ADA compliant.

Make access easier. If possible, remove any architectural barriers such as stairs that might prevent access to services. When this is not possible, look for alternative methods of dealing with children with limited mobility or other access issues. For example, a small child could easily be carried up or down a flight of stairs.

Make your facility friendlier. Assess what types of assistive equipment, facilities, and services you already have, and consider those that you could add easily based on your budget and existing physical facility. Specialized equipment required for a child's care might include ramps or handrails for access, wheelchair lifts, special washroom facilities, areas for specialized therapy, extra storage space, or communication devices and services such as readers. The responsibility for such equipment and related services usually rests on the childcare provider. The law states that such equipment will be provided by the childcare program unless it would cause an undue burden, so determine what you can and cannot comfortably provide to a child and his family.

Learn from others. It is important to remember that you are not in this alone. Many colleagues and groups in the community will rally to your aid if you ask. You can learn about many specialized services from local resources. The Association for Retarded Citizens (ARC), a national organization for people with disabilities and their parents, recommends checking with the following resources in your community for assistance:

• Family support groups;
• Therapists/specialists who provide services to children with disabilities;
• Mental retardation and disability-related agencies;
• Voluntary organizations which represent families and people with disabilities (such as the ARC);
• Professionals who advocate for or work with children with disabilities;
• Other childcare programs that currently include children with disabilities; and,
• Local/state/federal government-supported programs for children with disabilities.

Including children with disabilities in mainstreamed services seldom poses insurmountable problems for the caregiver. The transition usually is easy. Any problems usually lie in perceptions and attitudes and you and the children soon can realize the benefits of including Johnny in your program!

By Marilyn Grechus, MSE, Phd.
Assistant Professor of Health Education, Central Missouri State University

When is it Okay Not to Accept a Particular Child?

While it is your responsibility as a provider of quality care to be open to all children, including those with disabilities, there may be situations where accepting a child into your care is not appropriate.

• As noted in the article, adapting your childcare program to serve a particular child with disabilities may be financially or physically unreasonable and cause you undue burden.
• What if you have a waiting list for your services? The ADA does not require that a child with special needs be placed ahead of others.
• The ADA does not cover children who pose direct threats to themselves or others. You are not required to accept a child who is a substantial risk to the health and safety of your staff or the other children in your care. But remember, this cannot be determined through generalizations or stereotypes about certain disabilities. It must be determined through specific questions concerning the child's medical conditions or illnesses. For example, infectious tuberculosis would pose a threat to others while HIV/AIDS, which is not spread through casual contact, would not be grounds for exclusion. Of course, universal precautions are essential to prevent the spread of any disease!
  

Resources

Parent Advocacy Coalition for Education Rights, 4826 Chicago Avenue South, Minneapolis, MN 55417-1098; 888-248-0822 (nationally); www.pacer.org/pride/chldcare.htm

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