Inclusion: The Who, What, and How

1. Inclusion: The Who, What, and How With an Emphasis on the Mandates and State Strategies That Make It Work Abby Cohen, JD NCCIC Technical Assistance Specialist for Administration for Children and Families Region IX NECTAC Inclusion Institute July 14, 2009

2. Agenda • Who are the children of interest? • What disabilities are we concerned with? What laws? • What is inclusion? • What State policy strategies have been instituted to promote inclusion? 2

3. Background Who Are the Children We Are Talking About? 3

4. Who and How Many Children Are We Talking About? • 11.3 million children younger than the age of 5 are enrolled in some form of child care • 21.8 percent of households have a child with a special health care need, and approximately 10.2 million children younger than the age of 18 have a special health care need Sources: U.S Census Bureau. (2008). Who’s minding the kids? Child care arrangements: Spring 2005: Detailed tables. Retrieved November 21, 2008, from www.census.gov/population/www/socdemo/child/ppl-2005.html; Health Resource and Services Administration. (n.d.) The National Survey of Children With Special Health Care Needs, Chartbook 2005–2006: Prevalence of CSHCN: Individuals and households. Retrieved November 20, 2008 from http://mchb.hrsa.gov/cshcn05/NF/1prevalence/individuals.htm 4

5. Who and How Many Children Are We Talking About (con.)? • A recent Pediatrics journal article found that approximately 13 percent of children in its sample had developmental delays, making them eligible for Individuals with Disabilities Education Act (IDEA) Part C services • The study found that the prevalence of developmental delays is much higher than previously thought • For purposes of comparison, in 2002, Part C served 2.2 percent of children younger than 3 Source: Rosenberg, S. A., Zhang, D., & Robinson, C. C. (2008, June). Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics, 121(6). Retrieved November 20, 2008, from www.pediatrics.org/cgi/content/full/121/6/e1503 5

6. Who and How Many Children Are We Talking About (con.)? • Head Start (HS), the federally funded child development program for children in poverty, requires that at least 10 percent of children served be those with disabilities • The latest data show that in 2006, 13 percent of enrolled children had a disability, with 49 percent diagnosed before entering HS and 51 percent diagnosed during the program year Source: Center for Law and Social Policy. (2008, June). Head Start participants, programs, families, and staff in 2006. Retrieved November 20, 2008, fromwww.clasp.org/publications/hs_pir_2006.pdf 6

7. Definitions of Disability • Americans with Disabilities Act (ADA) definition: • Physical or mental impairment that substantially limits one or more major life activities (not specific conditions but functional impairments); • History/Record of above; • Regarded as above; or • Associated with the above • Recent amendments broaden interpretation 7

8. Definitions of Disability, con. • States/Territories define “special needs child” for purposes of child care subsidy (i.e., the Child Care and Development Fund [CCDF]) • States/Territories have their own civil rights laws with varying definitions 8

9. Definitions of Disability, con. • IDEA for Section 619 of Part B: • A child who is a child with one of a specific list of conditions who, by reason thereof, needs special education and related services; at state option can include a child experiencing developmental delays and who, by reason thereof, needs special education and related services (see Section 602(3)) 9

10. Definitions of Disability, con. • IDEA for Part C: • An infant or toddler who needs early intervention because of experiencing developmental delay or has a diagnosed physical or mental condition that has a high probability of resulting in developmental disability; at state option can include at risk infants and toddlers as well as children who have received Part C and are now eligible for Part B until they enter kindergarten or elementary school (see “Section 602(16)” and “Section 632(5)”) 10

11. Child Care Compared to Special Education • A subset of children using child care are eligible for a child care subsidy under CCDF • A subset of children with disabilities are entitled to services under IDEA • Some children will be eligible for both • In child care, there will be more children with disabilities than are eligible for IDEA 11

12. What Is Inclusion? • Not really defined by law, though children with disabilities cannot be discriminated against, and if eligible under IDEA, are to be served in natural environments or least restrictive environments

13. Joint Position Statement:DEC and NAEYC • The Division for Early Childhood (DEC) of the Council for Exceptional Children and the National Association for the Education of Young Children (NAEYC) developed a joint position statement about early childhood inclusion, which states the following: • “Early childhood inclusion embodies the values, policies and practices that support the right of every young infant and young child and his or her family, regardless of ability, to participate in a broad range of activities and contexts as full members of families, communities and society” Source: Division for Early Childhood of the Council for Exceptional Children, & the National Association for the Education of Young Children. (2008). Early childhood inclusion: A joint position statement of the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC), Field review: October 28- December 15, 2008. Retrieved April 20, 2009, from www.dec-sped.org/uploads/docs/about_dec/position_concept_papers/Position%20Statement%20on%20EC%20Inclusion_Field%20review%2011_08.pdf

14. Position Statement: DEC and NAEYC, con. “The desired results of inclusive experiences for children with disabilities and their families include a sense of belonging and membership, positive social relationships and friendships, and development and learning to reach their full potential.” Source: Division for Early Childhood of the Council for Exceptional Children, & the National Association for the Education of Young Children. (2008). Early childhood inclusion: A joint position statement of the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC), Field review: October 28- December 15, 2008. Retrieved April 20, 2009, from www.dec-sped.org/uploads/docs/about_dec/position_concept_papers/Position%20Statement%20on%20EC%20Inclusion_Field%20review%2011_08.pdf

15. Joint Position Statement: DEC and NAEYC, con. “The defining features of inclusion that can be used to identify high quality early childhood programs and services include (1) access, (2) participation, and (3) supports.” Source: Division for Early Childhood of the Council for Exceptional Children, & the National Association for the Education of Young Children. (2008). Early childhood inclusion: A joint position statement of the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC), Field review: October 28- December 15, 2008. Retrieved April 20, 2009, from www.dec-sped.org/uploads/docs/about_dec/position_concept_papers/Position%20Statement%20on%20EC%20Inclusion_Field%20review%2011_08.pdf

16. Laws Relevant to Inclusionin Child Care Settings Federal and State/Territorial Laws Impacting Inclusion 16

17. Major Federal Laws Impacting Inclusion of Children in Child Care • ADA, newly amended • Section 504 (when Federal funding is involved) • IDEA (covers those entitled to early intervention and special education) • HS requirements 17

18. Major State/Territorial Laws Impacting Inclusion of Children in Child Care • Civil rights laws/local human rights ordinances • Child care licensing laws/regulations • Medical, nursing, and related health professions’ professional practice acts It is important to know all these laws and how they interact

19. Inclusion: State Strategies 19

20. Strategies to Promote Inclusion: Overarching Systems Review • Reports are sometimes issued, such as in New Mexico, with cross-systems recommendations to promote inclusion in child care 20

21. Strategies to Promote Inclusion: Licensing • Each State/Territory determines what programs are licensed and what conditions apply • Review of licensing statute and regulations • Are there barriers to inclusion? • Are there affirmative provisions to promote inclusion? 21

22. Strategies to Promote Inclusion Through Licensing • Eliminate barriers from licensing regulations, balancing access and safety • Identify specialized regulations that may not be warranted • Eliminate automatic staffing increases regardless of individualized assessments • Review ambulatory/nonambulatory issues in fire codes 22

23. Affirmative Licensing Regulations • Promote affirmative provisions in licensing regulations • Screening children at enrollment to help with ChildFind • If a child has an individualized education plan (IEP) or an individual family services plan (IFSP), having a provider, with consent, involved with it • Requiring that operators permit specialists to enter the facility to provide services and instruct personnel 23

24. Affirmative Licensing Regulations, con. • Ensuring facility accessibility (MA) • Providing/requiring medication administration training (CO, NY); allowing providers to administer medications (CA) • Including inclusion training as part of licensing requirements (IN)

25. Strategies to Promote Inclusion:QRS/QRIS • Quality rating systems/quality rating and improvement systems (QRS/QRIS) are a growing trend across States (18 with statewide systems) • Several States have chosen to incorporate standards that relate to the inclusion of children with special needs 25

26. QRS/QRIS Example:New Hampshire • New Hampshire requires that children and families of all abilities be welcomed, that programs be modified, and that reasonable accommodations be made to maintain children with special needs in programs • Documentation includes inclusive policies appearing in handbooks, promotional materials, and/or other written parent communications 26

27. QRS/QRIS Example:Delaware • 2 Stars: All staff are trained on inclusion best practices/written inclusion policy • 3 Stars: Program requests copies of IEP, IFSP, or intervention plan; assessment results with attempt to implement at least one part of plan 27

28. QRS/QRIS Example:Delaware, con. • 4 Stars: Program uses process to document and implement activities/instruction that helps child reach goals in intervention plan; with family’s permission, attempts to work with service providers who are working with children in the program 28

29. QRS/QRIS Example:Ohio • Step Two: All children except school age receive a developmental screening within 60 days of enrollment; referrals, if needed, are completed within 90 days • Step Three: Same as for Step Two 29

30. QRS/QRIS Example: Indiana • At level three, “Plans and environmental accommodations for children with special needs are evident” • Indicators include looking at written plans, space, adaptation of materials, and promotion of age appropriate self-help, and answering questions about differences in a matter-of-fact way

31. QRS Example:Pennsylvania • 2 Stars: Provider has obtained general information/facts about any of the special needs issues of children in care • 3 Stars: Basic information from special needs assessments is requested; all prescribed special needs treatments followed; if applicable, provider has copy of child’s IEP or IFSP and a written plan 31

32. QRS Example:Pennsylvania, con. • 4 Stars: All staff have at least 2 hours of training (during the last 2 years) on inclusive early education and care practices, including how to access local community health and human services resources for families 32

33. QRS Example:Pennsylvania, con. • In addition to the community resources/special needs section, there is a section about transition • Star 3: Program provides general information about transition procedures • Star 4: Local school transition policies, including special needs, are available and reviewed with parents prior to transitions 33

34. Strategies to Promote Inclusion: Subsidy System • Definition of who is a special needs child under CCDF is given to the States/Territories; some define it broadly and do not limit the definition to IDEA’s definition • Use of optional authority under CCDF to define children with disabilities eligible for care older than 13 but younger than 19 34

35. Strategies to Promote Inclusion: Subsidy System, con. • Taking into account increased costs of caring for children with disabilities in making eligibility determinations based on income: • “The income spent on any regular, ongoing cost that is specific to a child’s disability is excluded from definition of income” (Iowa) • “Recurring expenses for medical care or prescribed adaptive equipment for special needs children shall be subtracted from gross family income” (Maine) 35

36. Strategies to Promote Inclusion: Subsidy System, con. • Differing income standards • Families with a child with special needs are subsidized when gross monthly income is at or below 85 percent, continuing until 100 percent of State Median Income (SMI) • Other families are subsidized when gross monthly income is at or below 50 percent, continuing until 85 percent of SMI (e.g., in Massachusetts)

37. Strategies to Promote Inclusion: Subsidy System, con. • Some guarantee subsidy eligibility (12 States); some give priority over other CCDF eligible families • Some provide full-time care whether or not parents are available to provide care (e.g., in Massachusetts) • A number of States have special needs rates through the subsidy program (which may be flat rate increases, percentage increases, or individual documentation) • There is a lack of information about utilization and effectiveness of each method and how methods compare 37

38. Strategies to Promote Inclusion:Use of Quality Money • Increased use of screening and referrals in child care to early intervention/special education and health, including mental health—requires training and knowledge of systems • Enhanced child care resource and referral services (MD) • Inclusion specialists • Model programs 38

39. Strategies to Promote Inclusion:Quality Activities • Loans of special adaptive equipment or assistive technology • Grants for special adaptive equipment or assistive technology • Loans or grants for facility accessibility

40. Strategies to Promote Inclusion: Quality Money, Professional Development • Integrating training about inclusion into all early care and education professional development (revising curricula) • Providing supports/initiatives to enable the care of children with challenging behaviors • Providing targeted resources for training on inclusion 40

41. What Can You Share? • What are some of the barriers to inclusion at the policy level? • Are there examples of law or regulation provisions that have promoted inclusion? • What more can be done to promote inclusion at the policy level? 41

42. Resources • Access Board, www.access-board.gov • ADA homepage, U.S. Department of Justice, www.usdoj.gov/crt/ada/adahom1.htm • California Map to Inclusive Child Care, www.cainclusivechildcare.org • Center on the Social and Emotional Foundations for Early Learning, http://csefel.uiuc.edu 42

43. Resources, con. • Child Care Law Center, www.childcarelaw.org • DEC, Council for Exceptional Children, www.dec-sped.org • Healthy Child Care Consultant Network Support Center, http://hcccnsc.edc.org • National Early Childhood Technical Assistance Center, www.nectac.org • National Professional Development Center on Autism Spectrum Disorders, www.fpg.unc.edu/~autismpdC/ 43

44. Resources, con. • National Professional Development Center on Inclusion, http://community.fpg.unc.edu/npdci • National Technical Assistance Center for Children’s Mental Health, http://gucchd.georgetown.edu/programs/ta_center/ • SpecialQuest, www.specialquest.org; see especially for programs, www.specialquest.org/sqtm/supp/inc_plan_chklist_center.pdf • Technical Assistance Center on Social Emotional Intervention for Young Children, www.challengingbehavior.org 44

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