Enhancing Quality in Child Care and Education

1. Presents Quality in Early Child Care and Education Cultural Awareness in the Child Care The Americans with Disabilities Act and Child Care in California

2. Quality in Early Child Care and Education (page 1) • 83% of children are in the care of non-parental care providers an average of 35 hours per week. • High quality Early Childcare Education (ECE) programs positively affect children's development across every ethnic, cultural, and language group, and readies them for school. • Most U.S. ECE programs are rated mediocre, or worse. • Several factors impact the quality of an ECE program.

3. Factors That Impact the Quality of an ECE Program (page 1-2) • Relationships. The #1 factor that impacts the quality of an ECE program is the relationship between the child and the childcare provider. • Routine. Routines and structure feel safe and secure in familiar routines. Their absence can be stressful and negatively affect children’s development. • Provider qualifications. Teachers with more training are better able to help young children learn and grow. • Adult-to-child ratio. Smaller group sizes have less risks for injury, infection, and teach children better social skills. • Staff turnover. High staff turnover can be an indicator of the stability of the program, how staff are treated, and overall quality. High staff turnover also impacts children who need time to adjust to new relationships. Staff turnover is high in the childcare field due to low salary, inadequate benefits, and limited growth opportunities.

4. 3 Routines That Define a Day-in-the-Childcare (page 3) • Toileting/diapering • Sleeping/napping • Feeding Safety

5. Toileting/Diapering (page 3) • The American’s with Disabilities Act prohibits the requirement that a child be potty trained in order to attend an ECE program. Some children may never be potty trained. • Children must be supervised privately while using the toilet. • Toilet training approaches of the ECE program may differ from those of the parents causing conflict.

6. Sleeping/Napping (page 3) • Research has shown that the rate of SIDS is higher in ECE programs than in infants’ homes, especially when placed to sleep on their stomachs. ECE programs must place infants on their backs to sleep. • Napping polices should be loose enough to allow all children the opportunity to sleep; allow children to sleep longer or more often than the scheduled time; find activities for children who do not sleep or who wake up that prevent them from disturbing the children who are sleeping. • To prevent tooth decay, children should not be placed to sleep with bottles. If a parent insists the child needs a bottle, the program may choose to give the child a bottle containing a small amount of water.

7. Feeding Safety (page 3-4) • Follow formula preparation guidelines outlined in licensing regulations (State of California, 2002, Section 101427). • Unfinished bottles of formula or breastmilk may NOT be refrigerated for future consumption. • Programs should encourage and provide for breastfeeding. • No sharing breastmilk. If accidental sharing occurs, you must file an Unusual Incident Report with the licensing agency. • Hold infants while bottle feeding. • No honey until 1-year-old. • Consider including cultural foods when menu planning.

8. Accreditation Opportunities (page 4) • Family day care homes and child care centers can apply for accreditation. • Fewer than 15% of all programs are accredited. • There is funding through many childcare resource and referral agencies and First 5 programs. • Accreditation available through organizations such as National Association for the Education of Young Children (NAEYC) and the National Association of Family Child Care Providers (NAFCCP).

9. Assessing Programs for Quality (page 4) • Using the Early Childhood Environment Rating Scale to assess ECE programs. • There are 3 environmental rating scales. • Early Childhood Environment Rating Scale – Revised Edition (ECERS-R) • Infant/Toddler Environment Rating Scale – Revised Edition (ITERS-R) • Family Day Care Rating Scale (FDCRS)

10. The 7 Scales for Assessing Infant/Toddler ECE Programs (page 4) • Furnishings and Display for Children • Personal Care Routines • Listening and Talking • Learning Activities • Interaction • Program Structure • Adult Needs

11. The 7 Scales for Assessing Center-Based ECE Programs (page 4) • Space and Furnishings • Personal Care Routines • Language-Reasoning • Activities • Interaction • Program Structure • Parents and Staff Each item on the ECERS-R is ranked on a scale from 1 to 7, with 1 being inadequate to 7 being excellent. For a single item, scoring must start at 1, inadequate, and progress upward until the correct score is reached.

12. The 7 Scales for Assessing Family Day Care Programs (page 5) • Space and Furnishings for Care and Learning • Basic Care • Language and Reasoning • Learning Activities • Social Development • Adult Needs • Provisions for Exceptional Children

13. Using the CCHP Health and Safety Checklist (page 5) The CCHP Health and Safety Checklist is an 82-item assessment tool. It includes the following subscales: • Emergency Prevention/Poisons • Staff and Children’s Possessions • Special Needs • Hand Washing • Food Preparation/Eating/Sanitation • Oral Health • Outdoor/Indoor Equipment Review page 6 “What a CCHA Needs to do” for additional suggestions for improving ECE program quality. Pages 7-9 list several resources and organizations to assist you in improving your ECE program

14. Cultural Awareness in the ECE Program (Page 9) • With California being so diverse, there are various beliefs in the cause, prevention and treatment of illness. These beliefs direct how people maintain their health and/or cure illnesses, and may cause them to delay or avoid seeking medical care and impacts their health and safety. • Become knowledgeable of the cultures and beliefs of the families in your program. • Use this knowledge to educate the children and their families.

15. Cultural Competence (Page 9) The 5 essential elements for a culturally competent system of care include: • value, accept and respect diversity • have the capacity, commitment, and systems in place for cultural self-assessment • be aware of the dynamics that occur when cultures interact • have continuous expansion of institutionalized cultural knowledge • create adaptations to accommodate diversity

16. Bilingual Families (Page 10) • Because of California’s diverse population, a large percentage of children enter the public-school system as English learner students and their parents may not speak English. • Multicultural diversity in California has a weighty impact on ECE programs where families and staff from different cultural and generational backgrounds interact in the care and rearing of young children. These children deserve an early childhood education that is responsive to their families, communities, and racial, ethnic and cultural backgrounds.

17. Ten Keys to Culturally Sensitive Child Care (Page 10) • Provide Cultural Consistency • Work Towards Representative Staff • Create Small Groups • Use The Home Language • Make Environments Relevant • Uncover Cultural Beliefs • Be Open To The Perspectives Of Others • Seek Out Cultural And Family Information • Clarify Values • Negotiate Cultural Conflicts.

18. Serving Biracial and Multiethnic Children and Their Families (Page 10) https://youtu.be/n08BXI0OJXE The above link is a preview of the video training available from the Childcare Health Program (2003), and highlights the unique issues facing biracial and multiethnic children and offers guidance on helping them process their dual identities. The guide includes the following topics: ages and stages of identity development, identifying and responding to the unique needs of biracial/bi-ethnic families, and insuring cultural sensitivity in child care programs.

19. Disparities in Health Status of Racial/Ethnic Groups (Page 11) Areas of Discrepancies  - the list below highlights some of the major areas of discrepancies between the health status of racial/ethnic minorities and the white population: • Life expectancy • Infant mortality rates • Sudden Infant Death Syndrome (SIDS) • Cancer screening and management • Heart disease and stroke • Diabetes • HIV infection/AIDS • Infectious disease • Breastfeeding practice • Immunization rates

20. Underlying Factors for These Discrepancies (Page 11) • Socioeconomic status (e.g., low income and low education of parents) • Lack of access to quality health care (e.g., insurance coverage, preventive health services) • Behavioral and life style risk factors (e.g., smoking, substance abuse, excessive use of alcohol, high-fat/high-cholesterol diet, lack of physical exercise) • Environmental hazards in home and neighbor- hood (e.g., exposure to lead, asbestos, etc.) • Medical problems and chronic illnesses • Genetic factors (e.g., hereditary disease that passes on from generation to generation) • Discrimination and racism leading to increased poverty, unemployment, poor housing, etc.

21. Cultural Issues That Arise in ECE Programs (Page 12) ECE programs may need to develop policies that have cultural implications. It is imperative that the program explore the belief systems of everyone involved in order to determine if compromise is needed. Cultural conflict may arise when beliefs differ on the following issues: • Causes of Physical Illness • Causes of Disability • Causes of Mental Illness • Treatment of Illness and Specific Symptoms • Beliefs About Immunizations • Child-Rearing Practices

22. What the ECE Program Needs to do (Page 13) It is very important for the ECE program staff to develop cultural competence. There are three ways an ECE program can develop and maintain cultural competence without sacrificing health and safety standards. Cultural conflict may arise when beliefs differ on the following issues: • Learn about yourself, your culture, and your own health beliefs. • Learn about other cultures, especially their child-rearing practices, family interactions, and their health beliefs. • Model and utilize creative problem-solving strategies to negotiate cultural differences that may impede health and safety.

23. Ages and Stages of Racial/Ethnic Identity Development (Page 15-16) Review the charts on pages 15 & 16.

24. Cultural Awareness Self-Assessment (Page 17-19) Use the checklists on pages 17-19 to assess your cultural awareness.

25. Using the Mnemonic Tool “L.E.A.R.N.” (Page 19) L - Listen with sympathy and understanding to the patient’s perception of the problem. E - Explain your perceptions of the problem A - Acknowledge and discuss the differences and similarities R - Recommend treatment (or solution) N - Negotiate agreement

26. Cultural Negotiations Activity (Page 19) Divide into groups, discuss and apply the LEARN guidelines to the scenarios on page 19. Report back to the larger group.

27. The Americans with Disabilities Act and Child Care in California (Page 20) • The Americans with Disabilities Act (ADA) is a federal civil rights law that Congress passed in 1990. Among other things, the ADA prohibits discrimination by child care centers and family child care providers against individuals with disabilities. • In California, additional state laws protect people with disabilities. These laws guarantee full and equal privileges and services in all business establishments. This includes the California Disabled Persons Act, which states that people with disabilities or medical conditions have the same right as the general public to the full and free use of public places.

28. Three Groups of People Protected Under ADA Laws (Page 20) • People with a physical or mental impairment that substantially limits one or more major life activities; • People with a record (history) of a physical or mental impairment that substantially limits one or more major life activities; • People who are regarded as having a physical or mental impairment that substantially limits one or more major life activities

29. The Definition of “Physical or Mental Impairment” (Page 20) The term “physical or mental impairment” is defined in the Code of Federal Regulations and includes many conditions. • Physiological conditions, cosmetic disfigurement, or anatomical loss affecting one or more of the following bodily systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine • Intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disabilities • Contagious and noncontagious conditions such as orthopedic, visual, speech and hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, intellectual disability, emotional illness, specific learning disabilities, HIV/AIDS, tuberculosis, drug addiction, and alcoholism.

30. Application of ADA Laws to ECE Programs (Page 20) • The Title III of the ADA applies to all places of public accommodation, and almost all child care providers are places of public accommodation. • A child care provider, whether operating out of a center or a family child care home, is a place of public accommodation. • License-exempt programs are required to comply with the ADA if they are places of public accommodations. • Title III of the ADA contains an exemption for religious entities, and by extension for the child care programs they run. However, merely operating in a religious building does not meet the ADA exemption. • Any program that receives federal funds, and prohibits discrimination on the basis of disability under standards that are nearly the same as those used in the ADA. • A child care program run by a religious entity may also be covered under California’s Unruh Civil Rights Act and Disabled Persons Act, if it sells its basic child care activities or services to nonmembers and nonbelievers, and attendees are not required to adhere to the religious entity’s beliefs or values.

31. 3 Types of Reasonable Accommodations (Page 21) • Changes in policies, practices, or procedures; • Provision of auxiliary aids and services to ensure effective communication;and • Removal of physical barriers in existing program facilities. In practical terms, what is reasonable will vary. The accommodations must be based on individualized assessments of the child’s needs and the program’s ability to make the necessary modifications. Generally, the three most important variables are (1) the needs of a person with a disability, (2) the accommodations requested, and (3) the resources available to the program. A family child care home that has fewer resources and a smaller staff may not be required to make the same accommodation required of a larger center.

32. 3 Types of Unreasonable Accommodations (Page 21) • In cases of changes in policies, practices or procedures, the accommodation would fundamentally alter the nature of the program or services offered; • In the case of auxiliary aids and services, the accommodation would fundamentally alter the nature of the program or pose an undue burden (i.e., pose a significant difficulty or expense); • In the case of the removal of physical or structural communication barriers, the accommodation is not readily achievable. If removal of such a barrier is not readily achievable, the ADA requires providers to make services available through alternative methods if such methods are readily achievable.

33. The Process of Determining Reasonable Accommodations (Page 21-22) • Begin by discussing the child's accommodation needs with the parents. Are there already programs in place, such as a IFSP or IEP? • If parents & providers cannot agree, the courts will decide what is “reasonable”. • Keep information about child’s disability confidential, but educate all parents on the importance of inclusion.

34. More on ADA Requirements (page 22) • There are no additional staffing requirements for centers with disabled children. • Federal law requires Head Start programs to have at least 10% of the children they serve include disabled children. • ECE programs may not have higher fees for disabled children. • ECE programs may charge parents for extra costs for non-childcare services, such as physical or occupational therapy. • Funding is available for severely disabled children.

35. Many ADA Accommodations Are Not Complicated (Page 22) • Accommodations can often be made without additional staffing. • Additional training is may be available from the parent, early intervention or special education specialists, health professionals, disability organizations, local resource and referral agencies, or community colleges. • An important first step is to identify community resources that can assist with inclusion. • By deciding to become professional caregivers, providers become responsible for complying with many types of laws. Like licensing laws, civil rights laws such as the ADA, the Unruh Civil Rights Act, and the California Disabled Persons Act, are a cost of doing business.

36. Terminating a Disabled Child (page 22-23) • Providers may not automatically decline to serve a child with disabilities, or refer them on to another provider who may be better able to serve them. • The family may be terminated from the program if it can be documented that the reasons for termination have to do with failure to comply with rules or standards that are uniformly applied to all families, not relevant to any potential required accommodations, and are not used as pretexts for discrimination. • The provider has an obligation to comply with the ADA and it is unlikely that a provider’s lawful compliance would open the provider up to civil liability.

37. Reporting ADA Discrimination (page 23) • If individuals feel they have been discriminated against, the individuals may file a complaint with the Department of Justice (DOJ) in Washington, D.C. about a potential ADA violation. • The DOJ will investigate the complaint. DOJ attempts to resolve most complaints through informal or formal settlement agreements, but may file lawsuits in federal court to enforce the ADA. Courts may order compensatory damages and back pay to remedy discrimination if the DOJ prevails. Under title III, the Department of Justice may also obtain civil penalties of up to $55,000 for the first violation and $110,000 for any subsequent violation. • A California parent who believes that his or her child is currently being excluded on the basis of disability can also contact Disability Rights California (DRC), at (800) 776-5746. DRC is the state protection and advocacy organization for people with disabilities.