Children with special needs in private day care centers

Children with Special Needs in Private Day Care Centers Albert Chang and Roy Teramoto University of California, Los Angeles ABSTRACT: A study of 27 pr ivate day care centers showed that less than ha l f enrol l chi ldren with special needs and they represent only 1% of the current enro l lment . Staff t ra in ing and professional hea l th consul tat ion are both needed if more such chi ldren are to be "mains t reamed" in private day care centers. The 1972 mandate which required Head Start programs to serve children with special needs brought to the forefront the philosophy of "mainstreaming" such children in early childhood education and day care programs. Although Head Start has successfully implemented this mandate (Nazzaro, 1974; U.S. Department of Health and Human Services, 1980) and much has been written on this subject in the education literature (Abelson, 1975; Guralnick, 1975; Klein, 1981), little is known about "mainstreaming" efforts in private (non-public funded) day care centers. In 1975, 37 (71.2%) of 52 day care centers surveyed in Berkeley, California, stated that "children with handi- capping conditions" were enrolled and of the remainder, ten would consider enrolling such children in the future (Chang et. al., 1978). Since the above survey included a large number of public funded programs (including Head Start) the percentage may be lower if only private centers are surveyed. At the suggestion of a practicing pediatrician who expressed con- cern about the difficulties encountered by parents of handicapped children while seeking child care, a pilot survey in the West Los Angeles-Santa Monica area was undertaken. The objectives were: 1. to enumerate and describe the types of handicapped children who are presently enrolled in private day care centers; 2. to define the perceived limitations in serving such chitden; and 3. to define what additional resources are needed by private child care centers if these wished to expand their enrollment of these children. In this report the terms "handicapped" and "special needs" are Requests for repr ints should be directed to A lbert Chang, Division of Populat ion and Family Health, School of Publ ic Health, Univers i ty of Cal i fornia at Los Angeles, Los Angeles, CA 90024. The authors would l ike to thank Laur ie Rozet of the Santa Monica Chi ld Care Resource and Referral Service and the day care center directors for the i r ass istance in th is study. Child & Youth Care Quarterly, 16(1), Spring 1987 60 @1987 by Human Sciences Press Albert Chang and Roy Teramoto 61 used synonymously. Head Start defines "handicapped" as "... men- ta l ly retarded, hard of hear ing, deaf, speech impaired, v isual ly handicapped, seriously emotionally disturbed, orthopedically im- paired, or other health impaired children or children with specific learning disabil it ies who by reason thereof require special education and related services" (U.S. Dept. of Health and Human Services, 1980). Since there was concern that the term "handicapped" might be interpreted only in the restricted sense of physical handicaps, the survey used the term "special needs" to encourage the respondents to include the largest number of children possible in their responses. Although this raised the possibility of l isting children who did not meet the Head Start definit ion of "handicapped," it was preferable to the alternative of omitt ing children who should be included. Method The survey was conducted during the summer months in 1982 (July, Au- gust, and September). A self-administered mail questionnaire 1 was developed and pre-tested with three center directors whose centers were located outside the study area. The questionnaire was sent to the directors of 34 centers which were randomly selected from a listing of 104 centers known to the Santa Monica Child Care Resource and Referral Service and which met the follow- ing three criteria: 1. enrolled preschool children; 2. operated at least six hours a day; and 3. was supported by private funds or parent fees. Two weeks after the initial mailing, a phone call was made to nonrespon- dents to verify that a questionnaire had been received, and the center's participation was again requested. Following an additional three weeks, a second questionnaire was mailed to those centers which had not responded. Differences in responses were tested for statistical significance by using the chi-square statistic. Results Respondents A total of 27 completed questionnaires were received. One ques- t ionnaire was excluded because the center only served school-age children. Therefore, questionnaires from 26 (79%) of a total of 33 centers are analyzed in this report. Characteristics of the Center The age range of children enrolled by the centers was three months to ten years. It should be noted that only one center enrolled infants 1 Available on request from the author. 62 Child & Youth Care Quarterly (under two years) while 18 centers enrolled school age children. The total number of children enrolled by the 26 centers was 1590. Twelve (46%) of the centers enrolled (or had enrolled in the past year) chil- dren with special needs. When these centers were compared with the 14 which did not enroll such children, there were no significant differences (chi square, p > 0.05) found with respect to number of enrolled children per center, number of hours of operation per day, number of staff members per center, and designation of an individual as health coordinator. Children With Special Needs There were a total of 25 children identified by the center directors as having special needs and who had been enrolled within the past year. More precisely, 14 were enrolled at the time of the survey and 11 had left the centers within the past year. In four cases, the family "had moved out of the area," in two cases each the child "could not adapt to the center" or "center could not meet the child's needs," one child began regular school, two children were cared for at home when mother had a new baby, and one transferred to another child care center within the community. Thus, the 14 children represent less than 1% of the current enrollment of these centers. Table 1 shows the conditions of the children, following the classi- fication of Head Start. Five of the children could not be readily classified and are shown in the category "other": these included a child whose mother abused drugs at the time he was born, a child allergic to bee stings, a child with a behavior problem, a child who came from a deprived background and who showed slight develop- mental delay, and a fifth child whose condition was not described. Staff Attention Required by Children With Special Needs Table 2 shows the areas of daily living activities (e.g. eating, washing, toileting, social interactions and free play) which were considered in regard to the perceived amount of staff attention the children with special needs required compared to their non-handi- capped peers. Children with emotional disturbance, mental retarda- tion, health impairment and hearing impairment were considered to require the "same or less care" in comparison with non-handicapped children. Administration of Medicine Only two of the 25 children received medications at the center. One had attention deficit syndrome (hyperactivity) and was receiving Albert Chang and Roy Teramoto 63 TABLE 1 Children With Special Needs Served by the 12 Centers and by Head Start Type of Handicapping Condition 12 Centers Head Start N % N % Total Speech Impairment 3 12 21,988 53.2 Health Impairment 3 12 5,118 12.4 Serious Emotional Disturbance 6 24 3,007 7.3 Physical Handicap 1 4 2,915 7.0 Mental Retardation 6 24 2,742 6.6 Specific Learning Disability - - - - 2,297 5.6 Hearing Impairment/Deafness 1 4 1,799 4.4 Visual Impairment/Blindness - - - - 1,473 3.5 Other Handicapping Conditions 5 20 - - - - 25 100.0 41,339 100.0 Ritalin, and the other child had cystic fibrosis and his medication was not specified. Limitations Cited by Centers Limitations in the staff training (9 centers) and lack of funds for special equipment (9 centers) were cited as the main reasons why children with special needs were not enrolled in the other 14 centers. Other reasons given were: no health worker to care for the children (8 centers), insufficient number of staff (8 centers), lack of funds for re- modeling physical facility (7 centers), inadequate space (5 centers), no applications from children with special needs (4 centers) and insufficient description of child's medical condition (3 centers). Most centers cited more than i reason. Additional Resources Requested by Centers Twelve of the 26 centers surveyed were will ing to begin enroll ing or enroll addit ional children with special needs. Of these, 7 already had at least one child with special needs enrolled within the past year. Thus only 5 of the 14 centers which were not enrolling children with special needs were interested in doing so. What are the main addi- tional resources needed for serving children with special needs? These were: better preparation of staff to know what to expect from such children (11 centers), a physician's description of the child's 64 Chi ld & Youth Care Quarterly TABLE 2 Perceived Amount of Staff Attention in Daily Living Activities Required by Children With Special Needs Compared to Other Children Type of Handicapping Condition (Number of Children) Number of Centers Indicating More and Same or Less Care is Required for Handicapped Children More Care Same or Less Care Needed Needed Emotional Disturbance (N = 6) Eating 1 5 Social interactions 6 - - Free play 5 1 Washing 1 5 Toileting 1 5 Mean 2.8 3.2 Mental Retardation (N = 6) Eating 2 4 Social interactions 5 1 Free play 1 5 Washing 3 3 Toileting 2 4 Mean 2,6 3.4 Speech Impairment (N = 3) Eating - - 3 Social interactions 3 - - Free play 1 2 Washing 2 1 Toileting 2 1 Mean 1.6 1.4 Health Impairment (N = 3) Eating 2 1 Social interactions 3 - - Free play - - 3 Washing - - 3 Toileting 1 2 Mean 1.2 1.8 Physical Handicap (N = 1) Eating - - 1 Social interactions 1 - - Free play 1 - - Washing 1 - - Toileting 1 - - Mean 0.8 0.2 Hearing Impairment/Deafness (N = 1) Eating - - 1 Social interactions - - 1 Free play - - 1 Washing - - 1 Toileting - - I Mean 0 1.0 Albert Chang and Roy Teramoto 65 condition (9 centers), better preparation of staff to handle such chil- dren (8 centers), more funds available (7 centers) and more staff available (6 centers). Again most centers expressed need for more than 1 additional resource. Discuss ion A prevailing view maintains that mainstreaming children with special needs enhances not only the development and learning expe- rience of these children but also provides positive benefits to non- handicapped children who interact with them (Klein, 1981). Despite this view, there are no studies which have examined the mainstream- ing efforts in private child care centers. For this reason, this pilot survey was undertaken. In this survey, only 25 children with special needs were enrolled in the past year in 26 centers with a total enrollment of 1590. This represents 1.3% of the total enrollment, and when only currently enrolled children were considered (14), they represent less than one percent. Several past nat ional and local surveys have shown that approximately 10%-15% of preschool children have chronic conditions and may be considered children with special needs (U.S. Department of Health and Human Services, 1981; Pless and Satterwhite, 1975). Therefore, while this survey is based on a small sample, it seems justifiable to assert that such children are probably underserved by private child care centers at present. Although the total number of such children served is small a significant percentage, 46% (12 out of 26) of centers have enrolled at least one child in the past year. With the additional five centers which expressed an interest in enrolling children with special needs, the total number of centers currently enrolling, or willing to enroll such children would be 17 centers or 65%. In this survey, there were no part icu lar factors which dis- tinguished centers which accepted children with special needs from those that did not. They were similar on number of hours of operation, number of children enrolled, number of staff, and staff to children ratio. An interesting finding was the types of medical conditions in the children served. Mental retardation and emotional disturbance were the most common conditions as contrasted with Head Start where speech impairment and health impairment are predominant. Since the survey sample was small it would be premature to conclude that this distribution is typical of private day care centers. One possible explanation might be that. public funded centers might complement 66 Child & Youth Care Quarterly private centers, i.e. children with certain conditions not served by one type of day care center would be served by the other. An unexpected finding was that some of the children with special needs were adjudged to require the same or less attention in certain areas of daily care, when compared with normal children. This aspect needs further study since the sample is small and the responses obtained were probably very subjective. The main focus of this survey was to document the extent of service provided by private day care centers for children with special needs. There is a clear need for more staff preparation and training in the basic aspects of daily care of such children. The involvement of health professionals was seen as very limited. This is an unsatisfactory situation since health professionals, particularly pediatricians, are seen as experts in child development and medical management of handicapping conditions. To what extent health professionals were directly involved in the centers already serving children with special needs was not possible to delineate in this survey. Although health professionals are supportive of mainstreaming handicapped children (Chang et. al., 1980) and recognize the importance of day care ser- vices for such children (American Academy of Pediatrics, 1973) there is a lack of guidelines as to what their role and extent of involvement should be. It should be noted that much more additional information is needed on the subject of mainstreaming children in private day care centers. More extensive surveys, both in geography and population, are needed to assess the real demand by families for child care. There is also need to survey health professionals who work with such fam- ilies and who understand their child care needs if the goal of more day care services for children with special needs is to be realized. References Abelson, A. G. (1976). Measuring preschools' readiness to mainstream handicapped children. Child Welfare, 55, 216-220. American Academy of Pediatrics, Committee on Children with Handicaps. (1973). Day care for handicapped children. Pediatrics, 51,948. Chang, A., Zukerman, S., & Wallace, H. M. (1978). Health services needs of children in day care centers. American Journal of Public Health~ 68, 373-377. Chang, A., Noonan, A., Gotdberg, A., & O'Neill, R. (1980). Pediatricians' involve- ment in and attitudes to child day care programs. Child Care Quarterly, 9, 124-131. Guralnick, M. J. (1976). The value of integrating handicapped and non-handicapped preschool children. Amen Journal of Orthopsychiatry, 46, 236-245. Klein, N. K. (1981). Disabled children need day care, too. Education Unlimited, January/February, 50-53. Albert Chang and Roy Teramoto 67 Nazzaro, J. (1974). Head Start for the handicapped--what's been accomplished? Exceptional Children, October, 103-107. Pless, I. B., & Satterwhite, B. B. (1975). Chronic illness. In Haggerty, R. J., Roghmann, K. J. & Pless, I. B. (Eds.). Child health and the community. New York: Wiley. U.S. Department of Health and Human Services, Head Start Bureau. (1980). The status of handicapped children in Head Start programs. Seventh Annual Report of the U.S. Dept. of Health, Education, and Welfare to the Congress of the United States on Services Provided to Handicapped Children in Project Head Start. Washington, DC: Head Start Bureau. U.S. Department of Health and Human Services, National Center for Health Statis- tics. (1981). Prevalence of Selected Impairments, United States, 1977. (Vital and Health Statistics, Series 10, No. 134). Washington, DC: National Center for Health Statistics.