Choosing Child Care For A Child With Special Needs

What Are Your Options?

This section provides a brief overview of the types of child care available. BANANAS has other Handouts with more information on these particular types of care: “Choosing Family Child Care,” “A Closer Look at Family Child Care Homes Licensed for 12 or 14,” “Choosing A Child Care Center,” “What Is Alternative Child Care,” “Choosing Infant or Toddler Child Care” and “Choosing School-Age Child Care.” You may want to review some of these Handouts – available by mail, at our office or from our website – before beginning your search. Once you know what kind of care best suits your needs, visit our office or call our referral line, 658-0381, for free referrals to all types of care.

Family Child Care

These are programs operated in a provider’s home. A small family child care provider is licensed to care for either six or eight children; a large family child care provider is licensed to care for 12 or 14 children. Some family child care providers have experience caring for children with disabilities – either other children in care or members of their own families. Others are willing to learn. Family child care programs tend to offer flexible hours – they often open earlier and stay open later than centers. Because of the small group size and the relative flexibility of some providers, family child care is always an option to consider.

Child Care Centers

These are licensed facilities which operate in non-home settings. A few centers serve only children with special needs. Other centers include children with special needs in their programs. BANANAS staff can give you referrals to either type of center. Centers generally serve larger groups of children (15 or more) and most separate children by age groups.

Both center-based care and family child care are licensed by the State of California, Department of Social Services, Community Care Licensing (CCL). The license is a health and safety check of the facility and does not insure the quality of care. Only parents can insure quality by careful evaluation. You have the right to check the license history of any provider by calling CCL, (510) 622-2614. Parents also have the right to obtain any licensing report that documents a facility visit or substantiated complaint investigation directly from the provider. BANANAS welcomes information – positive and negative – from parents, and we hope you will call us with your concerns. However, we have no authority to monitor, investigate or revoke licenses.

In-Home Caregivers/Babysitters

These are people who care for your child in your home. This type of care is more expensive than either family child care or a center. Teenagers typically charge $6 or more per hour; adult rates normally begin at $10/hour. Use in-depth interviews, reference checks and a trial period to choose an appropriate in-home caregiver. See our “Where and How to Look for a Caregiver to Work in Your Own Home” Handout for more information.

Shared In-Home Caregiver Arrangements

This is a parent-created child care situation in which one caregiver is hired to care for the children from two or more families. This care is more expensive than family child care or center-based care but less expensive than each family hiring its own caregiver. Talk with parents in your neighborhood or whose children go to the same special services, physical therapist, doctor, etc. (For more information, request our “Shares” booklet which is available at our office for $3.)

In-home caregivers and share arrangements are completely controlled by the parent-employers. There is no license for either type of care. All the responsibility for screening, calling references and selecting a caregiver rests with the parent-employer. One screening technique is to ask the provider if s/he is in TRUSTLINE. In this program, which has been in operation since 1994, providers submit their fingerprints to the Department of Justice. If there is no criminal conviction or substantiated child abuse history, then the provider is listed in the TRUSTLINE Registry. Some parents are willing to help pay the $130 fee to screen a potential provider. Call (800) 822-8490 to find out if a caregiver is listed in the TRUSTLINE registry.

What about Cost?

Child care is a significant expense for families. Cost varies, based on the type of care, supply, demand and neighborhood. Your child’s disability does not automatically qualify your family for subsidized child care. Under the ADA, a child care provider cannot charge you more than other parents because of your child’s special needs. There are a number of child care subsidies available to the general public (see our “Subsidized Child Care in Northern Alameda County” Handout). Families receiving TANF who have children with special needs can be exempted from CalWorks’ welfare-to-work activity. If you choose this exemption, you are still subject to the five-year lifetime limit for receiving aid.

What Are Your Expectations Of Child Care?

Do you expect your child to receive special education services in child care or are you primarily looking for supervision and socialization? Do you want the caregiver to be trained to work with people with specific disabilities, or would you be willing to work with someone who is interested in learning something new? Child care services are not usually “school” or “remedial services.” Child care is care which meets your child’s developmental needs while you are at work, school or getting some time for yourself. Think about your expectations and share them with the providers you meet while you are searching for child care.

What Should You Ask A Provider?

In the beginning, you will have to spend a lot of time and energy calling, visiting and talking with child care providers. You will feel more confident about your choice if you have seen a number of programs. Begin by calling BANANAS and getting a list of programs.

Choosing child care is really one of the most difficult jobs a parent must do. Parents frequently ask, “How can I be sure?” We know that all of us want good child care for our children, but good child care means something different to each of us. To assist you in your search, we compiled a short checklist which focuses on care for children with special needs. You may find some items on the list are not important to you, or that some issues that are important to you are missing. Revise the following checklist as needed:

• What are your first impressions (feelings or thoughts) about the program? Do your first impressions change after a short visit?

• What are the provider’s attitudes toward disabilities in general, your child’s disabilities in particular? Is the provider patronizing, fearful, overprotective? Is there appropriate expression of interest and curiosity? Is there concern about the provider’s role? (When visiting center-based programs, you should make sure you meet and talk with the staff who will actually be caring for your child.)

• Is the provider warm and friendly, or do you sense hesitancy in treating your child as other children are treated? How does the provider interact with your child during the visit?

• Does the provider make “too big a deal” over your child’s condition? How does the provider make you feel?

• How does the program handle eating, sleeping, toileting, etc.? With reasonable accommodation, can your child be integrated into these established routines?

• Are parents encouraged to become involved in the program? Would you feel comfortable talking to the child care worker/s about a problem or concern?

• Does the program have other children with disabilities in care? Have they cared for children with special needs in the past? (You may want to request the names and telephone numbers of parent references. Follow through and call these families for their impressions of the care.)

• Does the provider appear willing to accept advice from a “team” of professionals and/or support services which work with your child? Does she seem interested in becoming a team member?

(Remember to request the other Choosing Child Care Handouts for additional information.)

BANANAS also publishes a Handout entitled “How Can I Care For A Child With Special Needs?” written for providers. You may want to obtain copies from BANANAS and take this Handout with you as you visit. Leave a copy of this Handout with any provider you are seriously considering, but who may have questions or doubts. The Handout stresses that children with disabilities are more like other children than they are different. It answers some questions providers may have about disabilities and lists books and organizations which can offer information and support to the child care program. Providers, under the ADA, are required to provide care for all children, regardless of their special needs. If a provider still has questions, s/he can call BANANAS.

What Should You Tell A Provider?

While you are searching for a provider, you don’t need to share your child’s whole story. Keep it simple. You should, however, give each provider enough balanced, appropriate information so the provider can begin to plan how to provide appropriate care for your child. For instance, if your child has a seizure disorder, you might tell each provider:

• That your child has a seizure disorder.
• Whether or not the child is on medication.
• The frequency with which your child experiences seizures (i.e. very seldom, once a month, etc.).
• What to do if a seizure occurs.
• In what ways your child is the same as any other child who attends the program.

Supplying the provider with less information or denying the possibility that there might be a seizure would be unfair. Withholding information could later be harmful to the child and/or cause hard feelings between you and the provider. Similar basic information should be given to each provider about your child’s particular disability so you can realistically discuss the type of child care you are seeking.

Making A Decision

Begin by reviewing the providers’ responses to questions on your checklist and examine your impressions of the programs you have visited. Next, narrow your list of programs to three or four. Figure out what things you feel good about with each of those programs and what areas worry you. Call programs back to get answers to remaining questions. Visit a program again if need be. Remember, choosing child care is much more than just checking off items on a list; it is a process which must be deeply rooted in your family’s ideas and beliefs. Think about issues which are important to you and your family. Evaluating all this information will help you find the program which will work for you and your child.

Once you have further narrowed your choice to one or two programs or providers, give them all the specific information needed to understand and provide good care. Tell them: √ What kinds of activities your child especially enjoys and does well.

• How your child lets you know what s/he wants or needs. Be as specific as possible – talks, cries, gestures, signs, a combination, etc.

• How your child gets around – walks, crawls, scoots, etc. And, let the provider know about any equipment the child uses – wheelchair, walker, crutches, braces.

• What kind of help is needed, if any, to feed your child or with any other daily or special activities.

• Whether a special diet is needed.

• Whether the child is toilet-trained or how toileting is being handled.

• How the child relates to children her own age, to older and younger children.

• The types and frequency of medication needed as well as any possible side effects.

• Whether your child is on a monitor, respirator or requires any particular treatment, i.e. suctioning.

• Any other special needs the child has.

• What kinds of activities are very difficult for your child, and what kind of assistance s/he may need in order to feel successful.

• Which other agencies or programs are providing services to the child.

Use each provider’s responses to this information in making your final decision.

Getting Off To A Good Start

You, your child and the provider need some time to get to know each other. Expect to help the provider become acquainted with your child and your child’s needs. Information which is obvious to you about your child’s routine may be totally unknown to the provider. Giving the provider written instructions is very helpful. Jot down notes of what you do routinely during the course of a day to support the child. Most providers welcome this information. Going through this process will also help you gain confidence in separating from your child.

If you and your child have had difficulty adjusting to child care in the past, it may be harder to get through the initial period of adjustment. You may find yourself interpreting small incidents as signs that the setting is not right when, in fact, this is not the case. Everyone needs time to adjust to new situations. Whatever the circumstances, try to enter and maintain the child-caring relationship with an open, optimistic frame of mind. Check out your feelings with the provider, incident by incident. Don’t let situations build to the point of explosion. All relationships take work and the parent-provider relationship is no exception.

On the other hand, do pay attention to your feelings. If you are frequently anxious about the care, you may be having serious doubts about your choice. You should also evaluate how your child feels. Pay attention to his/ her behavior and anything s/he says about the staff of the program. You may also want to talk about your concerns with members of the BANANAS staff or with other professionals who are involved in the care of your child. It is always possible that your first choice of a provider may not work well. Perhaps the chosen provider had an unrealistic picture of the child’s need(s). Perhaps your idea of what matters in a child care setting has changed. Or, perhaps, as your child grows and changes, a different setting is needed. These are only some of the possibilities. Don’t prolong the inevitable if you have serious doubts about the care.

Once you’ve honestly appraised the situation, either accept the setting or opt for a change. Make an appointment with the provider to discuss your concerns. If you feel the care is not appropriate, jointly develop a plan to give you time to look for new care and to help the child make a transition to a new program. (See our Handout, “Changes, Changes and New Beginnings,” for useful information.) BANANAS cares about you and your child. We will always help you look for other referrals to meet your specific needs.

If you feel good about the child care situation after the trial period, then enter into a final contract with the provider. Written contracts are better than oral agreements. The contract should be very specific on items such as rates, payments, when and how the provider expects to be paid, whether you pay for days missed due to your child’s illness or the provider’s vacation, etc. (See BANANAS’ other Choosing Child Care Handouts for more information on contracts.) If you and the provider have agreed on any special arrangements for your child, this should be written into the contract. Any subsequent changes should be added to the contract in writing. Clarifying these details before your child starts child care will allow you and the provider to focus on communicating about your child once the care starts.

Feeling Good About Your Decision

Remember to keep the provider posted about what is going on in your child’s life. Talk to the provider regularly about your child’s day in child care. Facilitate a relationship between your provider and the other people who work with your child. Keep everyone informed of the progress and problems your child may be experiencing. Share any good books, articles or other resources which may contribute to a better understanding of your child. You are your child’s best advocate and best suited to determine what is and what is not working for your child.

Adjustment to child care varies with each child. Some are settled within a week; for others, it may take months to become comfortable. Talk with your child (if this is appropriate) about the arrangements and pass on any relevant information to the child care program. If this is the first time your child has been in care, examine and identify your own feelings – sadness, guilt, anxiety, concern about sharing the child’s affection or worry about turning over the caregiving to another adult. Some concerns and feelings of this sort are normal and, in the beginning, you can expect to feel ambivalence. Try to come to terms with your feelings and not to pass on any negative messages to your child. These can only make the adjustment to child care more difficult. Make the best choice you can, choose a caregiver you trust and provide as much support as possible. These are the key ingredients to having peace of mind as a parent and to insuring a good child care environment for your child.

What If You Encounter Problems During Your Search?

If you feel that you have been unfairly rejected, remember that your child’s rights are protected under the ADA. Call BANANAS for a referral to an advocacy group which can give you more information and advise you on a course of action. You can also visit our office to use our reference library of parent resources on caring for children with special needs and inclusive child care programs. Remember, BANANAS has a long-standing interest in including children with special needs in child care. Our staff will be glad to support you in your child care search.

Family Support

For more resources and support in raising children with special needs, contact the Family Resource Network at (510) 547-7322.

(We’ve mentioned a number of BANANAS Handouts throughout this brochure. Send one stamp for every three Handouts you would like sent to you. Alternatively, get Handouts at our office or from our website, www.bananasinc.org.)\

BANANAS Child Care Information & Referral • 5232 Claremont Avenue, Oakland, CA 94618 • 658-7353 • www.bananasinc.org

© 1988 BANANAS, Inc. Oakland, CA. Revised 2003.