1. is a service of the Inclusion in Early Childhood Settings: Rights and Responsibilities INCLUSION INSTITUTE Presented by Abby Cohen, NCCIC Technical Assistance Specialist for Administration for Children and Families Region IX May, 2010 This presentation provides information, not legal advice.

2. 2 Agenda Background Laws, with an emphasis on ADA Resources

3. 33 Background Who Are the Children We Are Talking About?

4. 44 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 Approximately 10.2 million children younger than the age of 18 have a special health care need Sources: Fertility & Family Statistics Branch, Housing and Household Economic Statistics Division, U.S. Census Bureau. (2008). Who’s minding the kids? Child care arrangements: Spring 2005: Detailed tables. Retrieved March 9, 2009, from www.census.gov/population/www/socdemo/child/ppl-2005.html; Maternal and Child Heath Bureau, Health Resource and Services Administration, U.S. Department of Health and Human Services. (2008). The national survey of children with special health care needs, Chartbook 2005–2006. Retrieved March 9, 2009, from http://mchb.hrsa.gov/cshcn05/NF/1prevalence/individuals.htm www.census.gov/population/www/socdemo/child/ppl-2005.html http://mchb.hrsa.gov/cshcn05/NF/1prevalence/individuals.htm

5. 55 Who and How Many Children Are We Talking About (con.)? A recent study found that approximately 13 percent of children in its sample had developmental delays, thus eligible for Individuals with Disabilities Education Act (IDEA) Part C services 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 March 9, 2009, from www.pediatrics.org/cgi/content/full/121/6/e1503 www.pediatrics.org/cgi/content/full/121/6/e1503

6. 66 Who and How Many Children Are We Talking About (con.)? Head Start (HS), 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, from www.clasp.org/publications/hs_pir_2006.pdf www.clasp.org/publications/hs_pir_2006.pdf

7. 77 Laws Relevant to Inclusion in Child Care Settings Federal and State Laws Impacting Inclusion

8. 8 Background History of discrimination Attitudes toward people with disabilities Law both leads and follows Recognizing benefits of inclusion

9. 9 Distinguishing Types of Laws Enactment of laws to protect civil rights  Concern with discrimination by public accommodations  Concern with discrimination by publicly funded entities Enactment of laws to provide services by entitlement

10. 10 Primary Federal Laws Civil rights laws  Section 504 of the Rehabilitation Act of 1973 applies to federally funded programs  The Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008 provide equal rights to public accommodations

11. 11 Primary Federal Laws, con. Entitlements to services  IDEA of 1975 provides specified services by right to eligible persons with disabilities; reauthorized in 2004

12. 12 ADA Structure Prohibits discrimination in or by the following:  Employment (Title I)  State and local governments (Title II)  Public accommodations (Title III)  Public transportation (Title II[b] and Title III[b])  Telecommunications (Title IV)

13. 13 ADA Definition of Disability A physical or mental impairment that substantially limits one or more major life activities When determining whether a disability is present, mitigating or corrective measures are not taken into account (e.g., medicine or prosthesis)

14. 14 Major Life Activities Federal law defines major life activities to include the following:  Walking  Seeing  Hearing  Learning  Taking care of oneself

15. 15 ADA Protects Several Groups Individuals with disabilities as defined by ADA Individuals with a record of having disabilities Individuals who are regarded as having disabilities Individuals or entities associated with people with disabilities

16. 16 Direct Threat: A Narrow Exception Rarely, people with disabilities who pose a significant risk to others may be excluded if risk cannot be eliminated by modifications  Exclusion due to risk is an exceptional case; this is not the typical child who bites!

17. 17 Public Accommodations No public funding required; simply must be open to the public Programs operated by religious organizations are exempt Child care centers and family child care homes are covered U.S. Territories must comply; Tribes cannot be sued by individuals, but can be sued by the Federal Government

18. 18 When Programs Are Required to Admit a Child With a Disability Scenario: A parent requests to enroll his/her child with a disability in a child care program The program should evaluate the individual needs of the child with a disability The program should follow the evaluation process to determine the child’s/program’s rights and responsibilities

19. 19 Does the child’s condition pose a direct threat? Renovated area and new facilities (after 1/26/96) must be fully compliant with ADA Accessibility Guideline regulations Is this a new facility or are major renovations being made? Identify ways to reasonably accommodate the needs of the child. This child cannot be reasonably accommodated at this point. Reassess when the direct threat can be eliminated Can the direct threat be eliminated through reasonable modifications? YesNo Do you need to reasonably modify policies, practices, and procedures to accommodate the child? Do you need to remove any architectural barriers from an already existing facility to accommodate the child? Will providing this impose an undue burden or fundamentally alter the nature of your program? Will changing policies and practices fundamentally alter the nature of your program? Will removing barriers be readily achievable? The child can be reasonably accommodated. Admit the child into your program. This child does not need to be accepted by your program now. If reasonably possible, set long-term goals to enable your program to meet similar needs in the future. No Yes No Yes No Yes No Yes No Yes No Does the child need auxiliary aids and services to ensure effective communication? Are there any reasonable alternatives to accommodate the child? Yes No

20. 20 What Must Providers Do? Develop eligibility/admissions criteria that do not screen out or tend to screen out persons with disabilities Make reasonable modifications to policies, practices, and procedures Provide for equally effective communication Comply with physical access requirements

21. 21 Overarching Notion of Reasonable Accommodations Examine program resources, tax credits and deductions (IRS Code Sections 44 and 190), and any available community resources Provide individualized assessment What is reasonable is based on conditions at a particular point in time, and this can change!

22. 22 Eligibility/Admissions Must eliminate all eligibility criteria that explicitly state children with disabilities cannot be included Must eliminate admissions criteria such as “toilet trained,” unless it is clear that this does not apply to children with disabilities May impose legitimate safety requirements if necessary for safe operation

23. 23 Eligibility: Charges Providers may not impose a surcharge on a person with a disability to cover the costs of measures that are required under ADA States are not precluded from paying more under ADA (in other words, there may be a special needs subsidy rate)

24. 24 Modification of Policies, Practices, and Procedures Providers are required to make reasonable modifications to policies, practices, and procedures unless the changes would fundamentally alter the nature of the program If a modification would fundamentally alter the program, providers must determine if a reasonable alternative exists

25. 25 Examples Changing snack time or nap time Eliminating a no-medication policy Doing blood-prick testing Providing visual cues of transitions Assisting with the positioning of a leg brace Allowing specialists to work with a child during program hours What examples do you have?

26. 26 Fundamental Alteration Very limited exception Requires more than discomfort or inconvenience Must “turn the program upside down” Insulin injection may be fundamental alteration

27. 27 Medication Administration/ Health Procedures Must administer medication if it is considered a reasonable accommodation (Alvarez v. Fountainhead, 55 F. Supp.2d.1048, N.D. Cal. 1999) Several States require specialized training in medication administration (e.g., CO, CT, DE, NY, UT, WV, WY) Settlements involving the U.S. Department of Justice (DOJ): Inhalers, Epi-Pens, and blood- prick testing In CA: With conditions, insulin pumps, G-tube feeding, glucagon injections

28. 28 Effective Communication Ensure the provision of effective communication  Provide auxiliary aids and services  Not required if it would result in a fundamental alteration or undue burden (i.e., a significant difficulty or expense)

29. 29 Examples Buying large print books Learning sign language with an infant or toddler Using picture cards

30. 30 Removing Barriers to Physical Access Three situations  Existing facilities  Major alterations/renovations to facilities  Newly constructed facilities

31. 31 Existing Facilities Buildings built or renovated before 1993 undertake “readily achievable” architectural modifications Readily achievable means easily accomplishable and able to be carried out without much difficulty or expense

32. 32 Examples Permanent or temporary ramps Grab bars in restrooms Wide doorways Furniture placement Have you done an accessibility assessment?

33. 33 Alterations Alterations means changes that affect usability (i.e., remodeling and renovation) If made after 1992, the facility shall be made to ensure that, to maximum extent feasible, altered portions are readily accessible and usable; effectively follow ADA accessibility guidelines, with some distinctions

34. 34 New Construction Child care facilities built or major renovations made after January 26, 1993, must comply with the ADA Accessibility Guidelines Guidelines for children’s environments and play areas have been developed, but are not yet U.S. DOJ regulations

35. 35 Access Guidelines Extensive information about access guidelines is available at www.access-board.gov www.access-board.gov Information includes play area guide and FAQs

36. 36 Enforcement Law is enforced via private lawsuits or by the U.S. DOJ DOJ can seek imposition of civil penalties up to $55,000 for the first violation

37. 37 Title II(a) Provisions Nondiscrimination in governmental/public body services, programs, and activities Includes school district programs, park and recreation, etc.

38. 38 Distinctive Provisions “Qualified” individual with a disability: Must meet essential eligibility requirements for receipt of services Someone who poses a direct threat is not qualified A public entity may offer separate or special programs, but individuals with disabilities cannot be denied access to standard programs

39. 39 Distinctive Provisions, con. Must provide “program accessibility” unless to do so would create a fundamental alteration or undue financial or administrative burden; consider possible alternatives Determination should be made by head of agency (with written findings)

40. 40 Distinctive Provisions, con. Must provide equally effective communication unless to do so would create a fundamental alteration or undue financial or administrative burden

41. 41 Title II: Administration Requirements Develop a grievance procedure Designate a compliance officer Conduct a self-evaluation Provide information about Title II requirements to the public Enforced through the U.S. DOJ, Office of Civil Rights, Department of Health and Human Services, the U.S. Department of Education, or through Federal district court

42. 42 Section 504 Covers Federal Government executive agencies Applies only to entities receiving Federal funds (the Child and Adult Care Food Program, the Child Care and Development Fund, HS, etc.) Similar protections to Title II of ADA No religious exemption States have no immunity from suit In education settings, includes FAPE

43. 43 State Law Equivalents Determine if your state law parallels or provides greater protection than ADA, Section 504.

44. 44 IDEA Federal entitlement to services These are responsibilities of the states/school districts, not private programs Part B deals with children 3 to 21 years of age  Section 619 of Part B deals with children 3 to 5 years of age Part C deals with infants and toddlers, birth to age 3

45. 45 Part B Children ages 3 to 5 who meet eligibility requirements are guaranteed a free appropriate public education (FAPE) Services must be provided in the least restrictive environment (LRE), which includes child care settings

46. 46 Eligibility Mental retardation Hearing impairment, including deafness Speech or language impairment Visual impairment, including blindness Serious emotional disturbance Orthopedic impairment Autism

47. 47 Eligibility, con. Traumatic brain injury Other health impairment Specific learning disability Deafness/blindness Multiple disabilities … AND needs special education

48. 48 Least Restrictive Environment (LRE) Settings other than gen ed can only be used if the nature or severity of the disability is such that regular classes with the use of supplementary aids and services is not successful.

49. 49 Individualized Education Program (IEP) Children found eligible under Part B are entitled to have an IEP developed by a team including parents and professionals This specifies the child’s special education, related services, supplementary aids and services, etc.

50. 50 Part C Eligibility includes the following:  Children with developmental delays  Has a diagnosed physical or mental condition that has a high probability of resulting in developmental delay;  At state option, children at risk of having substantial developmental delays

51. 51 Natural Environments Includes a child’s home “Community settings in which children without disabilities participate,” such as child care It is presumed that services will be offered in natural environments because if they are not, a justification must be provided

52. 52 Natural Environments con. Settings other than natural environments can only be used if early intervention cannot be achieved satisfactorily for the infant or toddler in a natural environment.

53. 53 Individualized Family Services Plan (IFSP) Children eligible under Part C are entitled to an IFSP developed by the IFSP team which includes parents and professionals Early intervention services necessary to meet the outcomes are detailed

54. 54 Resources Access Board, www.access- board.govwww.access- board.gov ADA homepage, U.S. DOJ, www.usdoj.gov/crt/ada/adahom 1.htm www.usdoj.gov/crt/ada/adahom 1.htm

55. 55 Resources, con. Center on the Social and Emotional Foundations for Early Learning, http://csefel.uiuc.edu http://csefel.uiuc.edu Child Care Plus+: The Center on Inclusion in Early Childhood, www.ccplus.orgwww.ccplus.org Center for Inclusive Child Care, www.inclusivechildcare.org www.inclusivechildcare.org Education Law Center, www.edlawcenter.org National Early Childhood Technical Assistance Center, www.nectac.orgwww.nectac.org Special Quest, www.specialquest.orgwww.specialquest.org

56. Thank You Prepared by NCCIC 10530 Rosehaven Street, Suite 400 ● Fairfax, VA 22030 Phone: 800-616-2242 ● Fax: 800-716-2242 ● TTY: 800-516-2242 Email: info@nccic.org ● Web: http://nccic.acf.hhs.gov NCCIC is a service of the 56