Caring for Our Children: National Health and Safety Performance Standards for Out-of--Home Child Care Programs, 2nd Edition was released by the American Academy of Pediatrics, American Public Health Association and the National Resource Center for Health and Safety in Child Care (NRC) in January 2002. The full edition of
Caring for Our Children, 2nd Ed. contains 707 standards and recommendations on all aspects on the health and safety of children in child care settings. These standards were developed by leading health and safety experts over a period of four years. Each standard includes rationale behind the need for such practices. The full edition is available on the NRC web site at
http://nrckids.org/CFOC/index.html. Print copies can be purchased from the American Academy of Pediatrics (www.aap.org) and the American Public Health Association (www.apha.org).
In an effort to make select subject areas more accessible to intended users, the NRC is developing smaller documents on specific subject areas. This document is a compilation of the standards related to the care of children with special needs* in child care settings.
The intended audiences for this document are:
state regulators and policy makers who want to promote the inclusion of children with special needs in child care settings in their state
child care providers who want guidance in serving children with special needs in their facility
health consultants and trainers who teach best practices for the inclusion of children with special needs
parents who are seeking information on appropriate practices for their children in child care.
The reader is encouraged to review relevant state statutes, regulations, state and county agency policies concerning specific situations or diseases. This publication focuses on national standards and does not address specific state and county requirements or variances from federal education law.
The first major thrust toward the development and implementation of services for children with special needs was the result of landmark legislation passed in 1975 P.L. 94-142 (the Education 0f All Handicapped Children Act and reauthorized in 1990 as P.L. 101-476 (the Individuals with Disabilities Education Act.
The Individuals with Disabilities Education Act (IDEA), amended in 2000(98), affords caregivers a unique opportunity to support children whose special needs might affect their educational success as well as impact upon both the children and families in other ways in the child care setting. The purpose of the law is to provide "free appropriate public education" regardless of disability or chronic illness to all "eligible" children, ages birth through 21 years, in a natural and/or least restrictive environment. Eligible children under IDEA include those with mental, physical or emotional disabilities, who, because of their disability or chronic illness, require special instruction in order to learn. Part B of this statute supports the needs of eligible preschool-age children through the local school district. Part C provides for a collaborative system to serve the needs of eligible infants and toddlers between the ages of birth and three years through early intervention. Child care programs can play a significant role in offering services required by children with special needs in the child care setting.
Information about IDEA can be obtained from the Office of Special Education and Rehabilitative Services (OSERS), U.S. Department of Education. Contact information for OSERS is located in Appendix BB.
Part C Supports Collaborative Efforts
Part C of IDEA makes federal funds available for states to implement a system of early intervention services for eligible infants and toddlers and their families. Each state must designate a lead agency. The lead agency can be the state education department, the state health department or another agency that will provide the assessment, coordination of services, and administrative functions required under Part C. The intent of Part C is to enhance the development of, and to provide other needed services for, infants and toddlers who have developmental delays or are at risk of developing such delays and to support the capacity of families to enhance the development of their children in the home and community. A further intent is to transition children to effective and inclusionary school-age services.
Although each state must designate a lead agency for implementing this federally funded program, the program is designed to be a coordinated, collaborative effort among a variety of state agencies for screening of children, assessment, service coordination and development of an Individualized Family Service Plan (IFSP) for every eligible infant or toddler and his or her family. The IFSP sets forth a plan for the early intervention services for an infant or toddler and the child's family, including family support and the child's educational, therapeutic, and health needs.
Among the more important aspects of this interagency model is the belief that children and their families should be viewed from the perspective of an ability model rather than a deficit model, i.e., emphasizing the strengths and capabilities of the family and child rather than the family's or child's perceived weaknesses. This means that the approach of the providers of services and supports identified in the Individualized Family Service Plan should be that of enhancing and supporting already-existing resources, priorities, and concerns of the child and family rather than assuming that services can correct "deficiencies" of the child or family.
The focus of services and supports to the child and family under Part C is the achievement of two related goals:
1) To enhance and support the development of young children with disabilities and chronic illness and minimize their need for special education and related services when they enter the public school system.
2) To maximize the potential for infants and toddlers with disabilities and chronic illness to enjoy the benefits of their communities and grow into adults capable of living independently, pursuing vocations, and
participating in the benefits their communities offer all citizens.
Serving Children in Natural Environments
Part C of the IDEA emphasizes delivery of services in natural environments. These are defined generally as settings that are "natural or normal for the child's same-age peers who have no disabilities." Natural environments reflect those places that are routinely used by families and typically developing children and represent a wide variety of options such as the child's home, the neighborhood, community programs and services such as child care centers, parks, recreation centers, stores, malls, museums, etc. By incorporating elements of the child's regular environment-furniture, toys, schedule, siblings, care providers, extended family, etc.-in the planning and delivery of services and supports, the family and providers can best discover the child's talents and gifts and enhance these in the normal course of play, relationships, and caregiving.
Learning about and understanding the child's routines and using real life opportunities and activities, such as eating, playing, interacting with others, and working on developmental skills, greatly enhances a child's ability to achieve the functional outcomes identified in the IFSP. For these reasons, it is critical to have a representative from the child care setting that the child attends or may attend at the table when the IFSP is developed or revised. It is also imperative that written informed consent is obtained from parents before confidential information (written or verbal) is shared among providers. For these same reasons, it is essential that a child care provider become familiar with a child's IFSP and understand both the role the provider is to play and the resources available through the IFSP to support the family and child care provider.
Other federal legislation, such as the Americans with Disabilities Act (ADA) (74) and Section 504 of the Rehabilitation Act of 1973 (75), prohibit discrimination against children and adults with disabilities by requiring equal access to offered programs and services. The IDEA promotes inclusion of infants, toddlers, and preschoolers in the same activities as their peers by providing support in the form of services and funds, some of which may be available to support eligible children in the child care setting.
Part B and the Individualized Education Program
Three-and four-year olds eligible for services under Part B of the IDEA are served through a written Individualized Education Program (IEP). This document is similarly developed by a team with the local education agency assuming responsibility for its implementation in either a public preschool program or a private preschool setting. Although federal funds are not specifically designated to support services provided by agencies outside of the public school system, local education agencies may contract with private providers for preschool services and cover educationally related services identified in the IEP, such as speech and language therapy, in the preschool setting.
Child care providers should become as familiar with a preschooler's special needs as identified in the IEP as they are with the services for an infant or toddler set forth in an IFSP. The provider may wish to send a representative, with prior informed written parental
consent, to the child's IEP review meetings to share valuable insight and information regarding the child's special needs in both the educational and child care settings.
The standards articulate those opportunities and responsibilities that child care agencies share with other agencies in serving a child with special needs, whether the child is served through an Individualized Family Service Plan or an Individualized Education Program.
Additional useful information is contained in the Appendices, for example, a list of adaptive equipment, emergency form for use in the care of children with special needs, etc.
Services for children with special needs continue to evolve. It is recommended that users contact their State Children with Special Health Care Needs Directors for the latest information. For a listing of state offices, see http://mchb.hrsa.gov/programs/blockgrant/directors.htm. Another good source for up-to-date information is the Association of University Centers on Disabilities at http://www.aucd.org.
For questions or assistance on these standards or
Caring for Our Children, 2nd Edition, please contact:
National Resource Center for Health and Safety in Child Care
the needs of eligible preschool-age children through the local school district. Part C provides for a collaborative system to serve the needs of eligible infants and toddlers between the ages of birth and three years through early intervention. Child care programs can play a significant role in offering services required by children with special needs in the child care setting.
