Questions Frequently Asked by Providers of Care for Children With Special Needs

Continue reading below the links.

Part One – Definitions & Requirements

Part Two – Misconceptions & Benefits

Part Three – Being on The Child’s Team

List of Medical Conditions & Disorders

List of Acronyms & Abbreviations

List of National Organizations & Resources

I have a small business. How can I possibly make all of the necessary changes?

The law has been crafted so the needs of the small business person were considered. Changes must be reasonable and easily achievable. For example, in most cases, it is relatively inexpensive to build a ramp, widen one exterior door, and equip a unisex bathroom (with appropriate signage, two grab-bars, elevated stool, open handled door handles, and a wider door). In addition, you might want to consider installing indoor-outdoor carpeting to help ensure the safety of children.

Costly structural changes are absolutely not required if affordable alternatives are available (e.g., providing pitchers and cups rather than raising or lowering water fountains or changing a hinge on a door to facilitate wheelchair clearance rather than knocking down a wall).

In short, child care providers in both centers and homes are required to make programs, services, and facilities available to children with disabilities. However, they are not required to add programs or services that are not provided for all other children. For example, if children ages 3-5 need to be potty trained to be admitted then the same rule would apply to children with disabilities.The ADA provides for equality, NOT for additional rights.

In this case, by spending a little money on renovations, you may be able to obtain tax credits from the Internal Revenue Service (IRS). Consult your tax adviser!

Will I need special training to care for a child with disabilities?

It depends on the child. Good basic child care skills and knowledge of child development are the foundation for quality care for all children. If caring for a child with disabilities does require additional skills, parents can often give you the training and information you need. Professional specialists who work with the child can also share tips, advice, and strategies. Research indicates that specialized instruction is an important component of quality, inclusive care. Support and technical assistance from parents and specialists may help to address a child’s individual needs.

Can I refuse to admit a child who has a disability if I have a policy to that effect?

No! In the past, various child care facilities have excluded children based upon policies.These policies are no longer possible and will not excuse you from meeting the ADA requirements. As long as the child with disabilities can be integrated and his or her needs can be reasonably accommodated, providers, regardless of how many children they serve, will be obligated under the ADA to admit the child.

What are my responsibilities for ADA as a business person?

As a child care center or family child care provider, you must be concerned about how ADA affects not only children but also possible employees who hap¬pen to have a disability. This includes anyone:

• Having a mental or physical impairment that limits one or more life activities

• Having a record of impairment or

• Having been regarded as possessing an impairment.

This law is unusual because it:

• Helps children with disabilities to be admit-ted to a regular child care or family child care facility. Disability alone cannot be a reason for denial.

• Makes it necessary to give consideration to qualified individuals with disabilities when employment opportunities become avail-able at the child care or family child care facilities.

• Requires that places of commerce (private businesses such as child care centers or family child care homes) make their programs, services, facilities, communication, and transportation accessible to individuals with disabilities.

ADA is NOT an affirmative action law. The child care or family child care provider has every right to employ the most qualified applicant. However, well-written policies and job descriptions are essential. Assessment procedures must fairly measure the potential of each applicant. Employers must be trained to interpret the Act’s provisions correctly when several applicants appear to be equally qualified. Finally, the provider must avoid making judgments based on disability rather than ability. For example, it is illegal to ask how a dis¬abled applicant would manage a lift on a bus. You could ask them to demonstrate how they would accomplish the task. You would have to ask every applicant to demonstrate the same thing.

What happens to my liability insurance when I enroll a child or person with a disability?

ADA requires that ALL child care centers and family child care facilities serve children with dis¬abilities. The ADA does not prohibit insurers from canceling or not renewing the policy based upon provision of programs or services to children with disabilities. However, there is little evidence that insurers raise rates for inclusive settings. Daily rates for ALL parents could be changed – spreading added costs among ALL families just as you would do with other expenses.

Are there special bookkeeping notations necessary when we enroll a child or person with a disability?

Not really. However, it is important to spell out the parent’s payment responsibilities in the event of the child’s absence, as should be done for all children. You should also keep accurate health and medical records on all the children enrolled in your program.

Can I get a tax break for making special accommodations?

Most likely you will not have to make major changes or spend extra money to serve children with special needs. If you do, you may be eligible for federal tax breaks to small businesses that make special accommodations for persons with disabilities. IRS Publication No.907 provides information on these provisions. You can get the publication by calling the IRS at 1-800-829-4933.

Our center has a policy that we will not give medication to any child. Can I refuse to give medication to a child with a disability?

No. In some circumstances, it may be necessary to give medication to a child with a disability in order to make a program accessible to that child. While some state laws may differ, generally speaking, as long as reasonable care is used in following the doctors’ and parents’ or guardians’ written instructions about administering medication, centers should not be held liable for any resulting problems. Providers, parents, and guardians are urged to consult professionals in their state whenever liability questions arise.

We do not normally diaper children of any age who are not toilet trained. Do we still have to help older children who need diapering or toileting assistance due to a disability?

It depends. To determine when it is a reason¬able modification to provide diapering for an older child who needs diapering because of a disability and a center does not normally provide diapering, the center should consider factors including, but not limited to: (1) whether other children without a disability are young enough to need intermittent toileting assistance when, for instance, they have accidents; (2) whether providing toileting assistance or diapering on a regular basis would require a child care provider to leave other children unattended; and (3) whether the center would have to purchase diapering tables or other equipment.

If the program never provides toileting assistance to any child, however, then such a personal service would not be required for a child with a disability. Please keep in mind that even in these circumstances, the child could not be excluded from the program because he or she was not toilet trained if the center can make other arrangements, such as having a parent or personal assistant come and do the diapering.

We diaper young children, but we have a policy that we will not accept children more than three years of age who need diapering. Can we decline admission of children older than three who need diapering because of a disability?

Generally, no. Centers that provide personal services such as diapering or toileting assistance for young children must reasonably modify their policies and provide diapering services for older children who need it due to a disability. Generally speaking, centers that diaper infants should diaper older children with disabilities when they would not have to leave other children unattended to do so.

Centers must also provide diapering services to young children with disabilities who may need it more often than others their age.

Some children will need assistance in transferring to and from the toilet because of mobility or coordination delays. Centers should not consider this type of assistance to be a “personal service.”

Must I provide special toys or equipment for children with disabilities?

Only in instances where the inclusion of the child with a disability in activities, programs, or services is contingent on the availability of that service, equipment, or toy. For example, it may be necessary to secure an interpreter, or a closed caption decoder, depending on the age and needs of a child with a hearing impairment. However, in many instances you can acquire the device from associations at no cost.

What about children with diabetes? Do we have to admit them to our program? If we do, do we have to test their blood sugar levels?

Generally, yes. Children with diabetes can usually be integrated into a child care program without fundamentally altering it, so they should not be excluded from the program on the basis of their diabetes. Providers should obtain written authorization from the child’s parents or guardians and physician and follow their directions for simple diabetes – related care. In most instances, they will authorize the provider to monitor the child’s blood sugar -or “blood glucose”- levels before lunch and whenever the child appears to be having certain easy- to-recognize symptoms of a low blood sugar incident.

While the process may seem uncomfortable or even frightening to those unfamiliar with it, monitoring a child’s blood sugar is easy to do with minimal training and takes only a minute or two. Once the caregiver has the blood sugar level, he or she must take whatever simple actions that have been recommended by the child’s parents or guardians and doctor, such as giving the child some fruit juice if the child’s blood sugar level is low. The child’s parents or guardians are responsible for providing all appropriate testing equipment, training, and special food necessary for the child.

What about children who have severe, sometimes life-threatening allergies to bee stings or certain foods? Do we have to take them?

Generally, yes. Children cannot be excluded on the sole basis that they have been identified as having severe allergies to bee stings or certain foods. A center needs to be prepared to take appropriate steps in the event of an allergic re-action, such as administering a medicine called “epinephrine” that will be provided in advance by the child’s parents or guardians.

Our center specializes in ‘group child care’. Can we decline admission of a child just because he needs individual attention?

No. Most children will need individualized attention occasionally. If a child who needs one-to-one attention due to a disability can be be integrated without fundamentally altering a child care program, the child cannot be excluded solely because the child needs one-to-one care.

For instance, if a child with Down syndrome and significant cognitive delays applies for admission and needs one-to-one care to benefit from a child care program, and a personal assistant will be provided at no cost to the child care center (usually by the parents or through a government program), the child cannot be excluded from the program solely because of the need for one-to-one care. Any modifications necessary to integrate such a child must be made if they are reasonable and would not fundamentally alter the program.

This is not to suggest that all children with Down syndrome need one-to-one care or must be accompanied by a personal assistant in order to be successfully integrated into a child care program. As in other cases, an individualized assessment is required. But the ADA generally does not require centers to hire additional staff or provide constant one-to-one supervision of a particular child with a disability.

Will admitting children with disabilities disrupt my day-to-day functioning?

No. You will still be able to use developmentally appropriate practices that emphasize individual growth patterns, strengths, interests, and experiences of young children. It will be relatively easy to integrate children with disabilities into a developmentally appropriate setting. Most changes are quite simple. For example, tactile materials can be used to meet the needs of a child with a visual impairment. Loving, caring, time, ingenuity, and good planning are among the ingredients needed to care for a child with disabilities.

What if other children’s parents are concerned that a child with special needs will take time away from their child?

It is not unusual for parents to fear that a child with special needs will take time and attention away from their child. Talk openly with parents about their concerns. Encourage them to share any concerns that they have now or later. When you are doing these things, remember to respect the privacy of all families in your program. Do not share any personal information without first get¬ting permission from the child’s parents.

TIP: Share the “Benefits ” Section of this guide with parents. Point out the benefits of inclusion to ALL children. Invite parents to be involved in your program and to participate in inclusive activities.

Are family child care homes also responsible for the implementation of ADA?

In general, the same rules apply. Children with disabilities must be able to get to, get in and use the facility. Family child care providers should participate in workshops in their area to learn about ADA. Becoming familiar with the needs of those with disabilities is a responsibility of the provider. Only those portions of the family child care home used in caring for children with disabilities must be made accessible.

How do I answer questions from other children about a child’s disability?

Children are curious by nature. They ask questions about differences in people. When children ask questions, give them honest and straight¬forward answers. Always use the child’s name in your answer. For example, “Chris gets food from that tube, just like you use a spoon.” Parents of children with special needs often become experts in dealing with questions from children and adults. Ask them for tips in answering any questions you are not sure about.

Can we exclude children with Human Immunodeficiency Virus (HIV) or Aquired Immunodefiency Syndrome (AIDS) from our program to protect other children and employees?

No. A center cannot exclude a child solely because he has HIV or AIDS. According to the vast weight of scientific authority, HIV/AIDS cannot be easily transmitted during the types of incidental contact that take place in a child care center. Children with HIV or AIDS generally can be safely integrated into all activities of a child care program. Universal precautions, such as wearing gloves, should be used whenever care-givers come into contact with children’s blood or bodily fluids, such as when they are cleansing and bandaging playground wounds. This applies to the care of ALL children, whether or not they are known to have disabilities.

If I rent space for my child care facility, who pays for changes to meet ADA requirements?

The law is really unclear on this issue. ADA only suggests how to handle this obligation. The law says that both the landlord and the tenant are re-sponsible. A general rule for implementation is:

1. The landlord should be responsible for “readily achievable” barrier removal and assistive devices located in “common areas” within a multiple unit structure such as an apartment or commercial building.

2. The tenant is responsible for making changes (that are readily achievable and with prior permission of the landlord) inside the rental unit used for child care.

As you renew your lease, you should clarify these obligations. Remember you must obtain the landlord’s written permission prior to making any permanent modifications to the structure unless you have blanket permission to do otherwise.

Back to Part One – Definitions & Requirements

Back to Part Two – Misconceptions & Benefits

Back to Part Three – The Child’s Team

List of Medical Conditions & Disorders

List of Acronyms & Abbreviations

List of National Organizations & Resources

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