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Infants and toddlers with special needs and their families.

Several recent trends reflect increased interest in developing and providing services for infants and toddlers with special needs and their families. First, evidence is mounting that indicates early intervention is valuable for diverse groups of very young children who exhibit a variety of special needs and for their families (Guralnick, 1991). Second, legal safeguards were established for the rights of individuals with disabilities, which have important implications for service-providing agencies and individuals. Third, there is much discussion about lowering the age for entering public schools (Gallagher, 1989). Fourth, more people are becoming aware of the need to provide greater support for child and family care (Kelley & Surbeck, 1990; Shuster, Finn-Stevenson & Ward, 1992).

Finally, a consensus is emerging that the functions of early intervention, child care and early childhood education (birth through age 8) are inextricably bound together; that "quality" or "best practices' cannot be achieved without systematically addressing the interrelationships among all three fields (Kagan, 1988, 1989; Mitchell, 1989; Salisbury, 1991; Sexton, 1990). In fact, Burton, Hains, Hanline, McLean and McCormick (1992) suggest that if quality early intervention, child care and early childhood education services are ever to become a reality, then it will be necessary to formally unify the three historically distinct fields.

Recognizing the widespread concern for infants and toddlers, including those with special needs and their families, the Association for Childhood Education International (ACEI) addresses three related issues in this position paper: 1) access to services, 2) quality assurance and 3) preparation of personnel. The final section offers some major conclusions and recommendations related to infants and toddlers with special needs and their families.


ACEI reaffirms its belief that all young

children and their families have a fundamental

right to quality care, education

and special intervention. ACEI leads the way in advocating for the right of all children and their families to quality care and education. For example, ACEI/Gotts issued a position paper on this fundamental right in 1988. Although children with special needs and their families are not explicitly addressed, the paper clearly argues for complete, open access to care and education as one of the most fundamental rights of all young children, including infants and toddlers.

Many other professional organizations support ACEI in its position on open access to services. In its guidelines for developmentally appropriate practices, the National Association for the Education of Young Children (NAEYC) unequivocally takes the position that all young children deserve access to a quality program (Bredekamp, 1987). The Division for Early Childhood (DEC) of the Council for Exceptional Children (CEC) issued a position paper supporting the right of young children with disabilities to education and care in settings with typically developing children (McLean & Odom, 1988). The Association for Persons with Severe Handicaps (TASH) adopted the position in 1988 that people with disabilities must have opportunities to achieve full integration into society (Meyer, Peck & Brown, 1991).

ACEI also recognizes the need for comprehensive and ongoing screening, monitoring and assessment services for all infants and toddlers and their families. The goal of such services must be to facilitate early identification of children's special needs and ensure provision of appropriate interventions. Early identification activities should be an integral part of a comprehensive early childhood system, birth through age 8, and needed interventions should be embedded within typical child care, education, home and health routines.

Further, ACEI recognizes and supports the legal right of children with special needs and their families to regular child care and education services. The 1991 amendments (P.L. 102-119) to Part H of the Individuals with Disabilities Education Act (IDEA) (P.L. 101-476) require early intervention services to be provided in regular settings with typically developing children, as appropriate for each child. The term "natural environments" is used to refer to regular settings for typically developing age peers.

In 1990, the Americans with Disabilities Act (ADA) was signed into law. The ADA rules went into effect January 26, 1992. All public accommodations are now prohibited from discriminating against individuals because of a disability. Under Title III of the Act, the law specifically includes nursery schools, child care centers and family child care homes in the definition of "public accommodation" (Rab, Wood & Stanga, 1992; Surr, 1992).

ACEI recognizes that increasingly diverse

populations of infants and toddlers

represent great challenges to

child care and education systems and

affirms the need for immediate action

to support these systems. The population of infants and toddlers entering or seeking entry into child care and education systems is changing to include special needs and at-risk children. Service providers and decision-makers must respond to these changes if children and families are to reach their full learning and developmental potential (Stevens & Price, 1992). "Special needs" and "at-risk" are popular terms used to describe an extremely heterogeneous population (Hrncir & Eisenhart, 1991). Care must be taken to consider the extreme diversity within a particular special needs or at-risk subgroup. For example, the popular media image of "crack babies," as Griffith (1992) notes, is that they are all severely affected and little can be done for them. In fact, the effects vary dramatically from infant to infant and are moderated or exacerbated considerably by other factors.

The special needs population requires particular attention not only because of its diversity, but also because of the large numbers needing services. As the following statistics illustrate, we clearly need to take immediate action.

* Each year, some 425,000 infants are born who will manifest a disability within the first four years of life (Garwood, Fewell & Neisworth, 1988). At the end of 1990, only approximately 600,000 children with special needs, birth through 5, were receiving intervention services (Hebbeler, Smith & Black, 1991).

* Some 350,000 to 375,000 newborns each year have been exposed prenatally to drugs, including alcohol (Pinkerton, 1991; Stevens & Price, 1992). Fetal alcohol syndrome (FAS) is now recognized as the leading known cause of mental retardation in the Western world. Conservative estimates indicate that approximately one in 500 to 600 children in the U. S. are born with FAS and one in 300 to 350 are born with fetal alcohol effects (FAE) (Burgess & Streissguth, 1992; see also, Cohen and Taharally, 1992).

* Each year, 412,000 infants are born prematurely (Bartel & Thurman, 1992).

* An estimated 16 percent of all American children (3 to 4 million children) have blood lead levels in the neurotoxic range (Neddleman, 1992).

* Human immunodeficiency virus (HIV) has become the greatest infectious cause of pediatric mental retardation in the U. S. In October of 1992, the Centers for Disease Control (CDC) reported 3,426 cases of acquired immunodeficiency syndrome (AIDS) among children under the age of 13 and estimated that several times as many children are infected with HIV (Seidel, 1992).

* An estimated 3,000,000 to 4,000,000 Americans are homeless (Eddowes & Hranitz, 1989; Heflin, 1991). The number of children in the U. S. who are homeless on any given night range from 68,000 to 500,000 (Linehan, 1992).

Much recent rhetoric by politicians and policymakers centers on ensuring that all children are ready to enter school (e.g., America 2000). In a recent survey of U.S. state expenditures, however, half of the states spend less than $25 per child on the care and education of young children and one-third of the states spend less than $17 per child (Adams & Sandfort, 1992). Feeg (1990) reminds us that the U. S. is ranked 18th among industrialized nations in infant mortality and compares poorly in protecting and immunizing well children.

These facts clearly indicate the need for immediate action at national, state and local levels to ensure that additional dollars are made available to support child care, education and health systems in providing high quality, comprehensive services for all children. Such support is critical as these systems begin to upgrade early care and education services for more traditional populations, while simultaneously providing quality services for less familiar, special needs populations.

ACEI affirms the position that child

care and education reform movements

must be inclusive, addressing

the needs of infants and toddlers with

special needs and their families

within the broader context of society. Recently, movements to "restructure" or "reform" the education and child care systems have gained much momentum. One such movement is America 2000 (U. S. Department of Education, 1991), a set of six national education goals developed by President Bush and the nation's governors. The first goal is of particular relevance to infants and toddlers with special needs and their families: "By the year 2000, all children in America will start school ready to learn." While this goal, widely touted as the cornerstone of America 2000, clearly focuses attention on the importance of learning during the early years, significant inherent problems remain.

First, children with special needs or disabilities are not specifically mentioned in this or any of the other goals. It is imperative that national programs value and include the needs of all children. The second problem is defining "readiness" according to an expected level of skills and abilities children should possess prior to school entry. Such an approach serves a gatekeeping function of keeping some children out and ignores the central question of how "ready" the education system is for the child (Kelley & Surbeck, 1991; Willer & Bredekamp, 1990). Gatekeeping to exclude children with special needs and their families from the mainstream, whether implemented consciously or unconsciously, is nothing new and is certainly not even remotely related to "restructuring" or "reform." As Bowman (1992) notes: What is a special-needs child? The usual answer is a child with a disability that prevents him or her from functioning effectively. But is the disability always in the child? I suggest that in most instances, the disability is not in the child, but in the misfit between the child and the environment. (p. 106)

ACEI receives support for this position from DEC, which issued a position statement on the first goal of America 2000, and from NAEYC, which endorsed the DEC statement (Holder-Brown & Parette, 1992).

ACEI strongly supports refocusing the reform and restructuring movements to recognize that school success is dependent upon families receiving the comprehensive health, education and social services they need in order to support children's development and learning, beginning with prenatal care. Willer and Bredekamp (1990) and Kelley and Surbeck (1991) argue for a restructured early childhood care and education system that extends well before and beyond the school and classroom to encompass health and human services.

An important step in this direction is the new Family Leave Law, which combines parental leave with disability insurance so that all families at all economic levels can afford to take time off to care for their children (Bond, Galinsky, Lord, Staines & Brown, 1991). New resources must be invested and current ones redirected to ensure that restructuring and reform efforts focus on making the system "ready" to respond to the needs of all children and their families.


Quality assurance must not be overlooked when attending to the crisis in child care, health care and early childhood education (Daniel, 1990; Kagan, 1988; Willer, 1987). Quality assurance issues for infants and toddlers with special needs and their families must be addressed within the context of ensuring that all young children benefit from developmentally appropriate practices. An integrated service system should be designed to support, and not supplant, the role of families.

All young children and their families have a right to expect that child care, health care, and education and intervention systems are designed to enhance and promote their well-being. To ensure that quality services are delivered, some definable, measurable quality indices must be established, validated and adopted by health, child care, education and intervention systems. Such an outcome requires the collaboration of individuals representing multiple agencies and programs, both private and public, as well as consumers. These stakeholders must undertake systematic efforts toward evaluating and developing the context for collaboration, including:

* setting clear and manageable goals

* developing an operational structure that matches

the goals

* developing mandates that are facilitative

* arranging for joint leadership

* pooling existing resources and identifying new ones

* establishing processes and policies that are clearly

understood. (Kagan, 1991)

ACEI affirms that standards for quality

infant and toddler programs must

be validated and adopted for all young

children, benefiting children, their

families and all of society. Several professional groups support ACEI (ACEI/ Gotts, 1988) in advocating for quality assurance standards for child care and early childhood education programs, including NAEYC (Bredekamp, 1987) and the Alliance for Better Child Care (National Association for the Education of Young Children [NAEYC], 1987). Also, the Division for Early Childhood of the Council for Exceptional Children (DEC/CEC) recently published quality indicators for early intervention programs (Division for Early Childhood/CEC, 1993).

The care and education standards promulgated by the early childhood and early intervention communities are similar in philosophy and content. The similarities most likely result from the growing recognition that all children benefit from care environments that are safe, responsive, developmentally appropriate and competency-enhancing. Care environments that meet these and other identified standards should promote children's well-being and, from a transactional/ecological perspective, that of families and society (Bronfenbrenner, 1986; Hamburg, 1991).

A large consensus group comprised of parents, practitioners, policymakers, researchers and advocacy groups from all early childhood communities must collaborate to ensure that appropriate standards for all children are validated and adopted. The accreditation process developed by NAEYC (1986) is certainly a welcome step in this direction.

ACEI recognizes that government regulation through child care licensing is one of the primary policy mechanisms for establishing and overseeing quality care (Kagan, 1988; Phillips, Lande & Goldberg, 1990). The battle continues on a state-by-state basis to establish licensing standards, with many states seeing an erosion in established standards due to nonenforcement or exemption (Lindner, 1986; Willer, 1987). There is no denying that quality early childhood programs require time and money, as well as commitment and broad-based support. Resources must be available to develop and maintain high quality programs that meet the needs of children, parents and staff.

ACEI affirms the position that quality

child care and education systems

must promote full inclusion. The most important indicators that must be present in early childhood quality assurance standards include those that address program policies, structures and practices supporting full inclusion of special needs children in settings designed for their age peers without disabilities (Demchak & Drinkwater, 1992; Hanline & Hanson, 1989; Salisbury, 1991). As Campbell (1991) notes, "More than any area of special education, the benefits of noncategorical programming where young children with disabilities are educated with those with typical development have been empirically supported" (p. 473).

Inclusion benefits both children and families. For example, children with and without disabilities benefit developmentally and socially from interaction in a child care environment that individualizes care and promotes ongoing regular contact among children (Demchak & Drinkwater, 1992; Odom & McEvoy, 1988). Families whose children experience inclusion frequently cite the development of empathy, respect for differences and respect for individuals as important outcomes for both themselves and their children.

Campbell (1991) makes the compelling argument that, beyond the cited benefits of inclusion, the real issue is whether we can justify removing children from the normal life experiences to which they are entitled by virtue of being young children. ACEI shares this view, affirming that infants and toddlers with special needs and their families should not be excluded from such experiences or from systems designed to serve all children and families. Developing one quality inclusive system of care, education and intervention can result in improved services for all children and families.

ACEI affirms the position that quality

child care, health care and education

systems must be integrated

and that individualized, or personalized,

care and education must be provided

all infants and toddlers and

their families. The unique characteristics of all infants and toddlers must be considered in developing quality care, education and intervention programs. As a group, infants and toddlers with special needs are extremely heterogeneous. Individualized care, education and intervention must be provided to capitalize on the unique characteristics of each child and family. In fact, provisions of Part H of IDEA require that intervention for infants and toddlers having known or suspected disabilities include an Individualized Family Service Plan (IFSP) that systematically focuses on the individual family's priorities, resources and concerns (Sexton, 1990).

Kelley and Surbeck (1990) note that individualization, or "personalization," of care is also essential for typically developing infants, toddlers and their families. No accepted, single standard exists regarding the nature of services provided young children prior to school entry. ACEI endorses the principle that services for infants and toddlers with special needs should be designed according to the same standards as those for all other infants and toddlers. Programs adhering to such standards will provide care and education that are individualized, family-directed and culturally normative.

ACEI affirms the position that quality

child care and education systems

must embed needed interventions for

infants and toddlers with special

needs within the natural routines,

schedules and activities of child care

and home settings. Quality child care and education systems must develop and utilize environments that promote active engagement of children with peers, adults and materials (McWilliam & Bailey, 1992). The learning environment should not be structured by strict schedules or insistence that children remain seated and quiet. Space, equipment, people and materials should be arranged instead to free children to move, choose and busy themselves. As Olds (1979) notes, "For all its manifestations, the environment is the curriculum" (p. 91). The true curriculum for infants and toddlers is everything they experience during the day (Bredekamp, 1987; Hignett, 1988).

Programs serving infants and toddlers with special needs should embed needed interventions within the natural routine or schedule of the child's day (Sexton, 1990). Needed special therapies (e.g., occupational, physical, speech, etc.) should be integrated within caregiving routines. Busenbark and Ward (1992) argue for integrated therapy that:

* lends itself to the inclusion and active involvement

of nondisabled peers

* is delivered in the child's natural environment

* affords opportunities for modeling intervention

strategies for staff and families during caregiving


* promotes focusing on child and family goals that

are realistic, appropriate, functional and meaningful

* improves the child's social interaction skills

* builds a strong collaborative partnership among

therapist, program staff and parents.


All disciplines concerned with infants and toddlers and their families agree that overall program quality or developmental appropriateness is determined directly by the knowledge and skills of the individuals caring for and serving this population (Bredekamp, 1987, 1992; Granger, 1989; Klein & Campbell, 1990; Kontos, 1992; Sexton, 1990). Available data indicate however, enormous personnel problems that demand immediate attention. Granger (1989) reports that the annual personnel turnover rate in child care and early childhood programs not located in public schools is as high as 40 percent. Kontos (1992) also estimates that the annual turnover rate among child care providers is approximately 40 percent. The results of several national surveys (Bailey, Simeonsson, Yoder & Huntington, 1990; Meisels, Harbin, Modigliani & Olson, 1988; U. S. Department of Education, 1990) and state surveys (Hanson & Lovett, 1992; McCollum & Bailey, 1991; Sexton & Snyder, 1991) clearly note that:

* there are critical shortages of early intervention

personnel across disciplines

* these critical shortages are predicted to continue,

or even worsen, in the future

* there is a dearth of training content at both undergraduate

and graduate levels related to working

with infants and toddlers who have special

needs and their families.

How adequately these and related personnel preparation issues are addressed will determine the future of our youngest children and the education profession (Bredekamp, 1992). A personnel system must be developed that addresses both preservice and inservice education needs.

ACEI promotes collaboration among

the fields of early childhood education,

child care, early intervention and supporting

disciplines in the design and

delivery of personnel training. One key issue in personnel preparation is whether preservice and inservice training programs for early interventionists should be developed and delivered in isolation or in collaboration with general early childhood and care programs. Miller (1992) argues convincingly against educating personnel to work with either "regular" or "special needs" young children. Concerns over segregated personnel preparation programs have resulted in collaborative efforts among numerous professional groups, such as NAEYC, Association for Teacher Educators (ATE) and DEC, to achieve consensus on personnel preparation issues (Bredekamp, 1992).

ACEI endorses such efforts as absolutely necessary and, in addition, advocates inclusion of related professional groups (e.g., American Occupational Therapy Association and American Speech and Hearing Association) in future efforts. Joint collaboration has the potential to help ensure that full inclusion of infants and toddlers with special needs and their families becomes a reality.

An integrated personnel preparation system is imperative for numerous reasons. First, Part H of IDEA mandates that infants and toddlers with special needs be cared for and served in natural environments available to their typically developing age peers. Therefore, personnel in education and care settings will increasingly educate and care for infants and toddlers with special needs within these more natural and normalized environments. Early interventionists will spend much more of their time providing technical assistance to education and care personnel, collaborating with them on transition and inclusion issues.

IDEA, Part H, also requires that specific early intervention services must be delivered by interdisciplinary teams. Collaboration and joint training must occur across related disciplines such as occupational and physical therapy, audiology, speech and language therapy, social work and psychology. An integrated and collaborative preservice and inservice training system is an efficient, effective mechanism to address shared and related competencies.

Second, a consensus is growing among historically distinct fields that, if quality child care, education and intervention are to be provided all infants, toddlers and their families, an interdisciplinary approach to personnel preparation must build on "core" competencies identified by different professional groups (Burton et al., 1992; Demchak & Drinkwater, 1992; Miller, 1992; NAEYC, 1988). These core competencies should serve as a basis for developing an integrated personnel system. For example, personnel competency domains (Table 1) have been identified by the Council for Early Childhood Professional Recognition in its Child Development Associate (CDA) requirements for infant and toddler caregivers (Council for Early Childhood Professional Recognition, 1992); NAEYC, in its developmentally appropriate practice guidelines (Bredekamp, 1987); and DEC, in its recommendations for certification of early childhood special educators (McCollum, McLean, McCartan & Kaiser, 1989).
Table 1: Core Competencies for Personnel Preparation
* Organize learning environments that are safe,
 healthy and stimulating.
* Promote all children's physical, intellectual,
 social, adaptive and communicative competence.
* Select curriculum and teaching/intervention
 strategies that: a) are developmentally appropriate,
 b) address all areas of development, c)
 are responsive to a wide variety of individual
 needs and d) are based on normal routines.
* Facilitate the success of children in all learning
* Collaborate with families in all aspects of care,
 education and intervention.
* Ensure that all practices are respectful of and
 sensitive to cultural diversity.
* Integrate academic and practical experience
 via field experiences such as practicum, student
 teaching/internship and technical assistance/support
 at the job site.
* Maintain a commitment to professionalism via
 interdisciplinary and interagency teaming,
 continuing education, and systems change
 through individual and group advocacy.

There is also growing recognition across fields that inservice or outreach training must receive priority within any personnel preparation system (Bruder & Nikitas, 1992; Granger, 1989; Kontos, 1992; Miller, 1992). Bailey (1989) defines inservice education as the process by which practicing professionals participate in experiences designed to improve or change professional practice. Given the high turnover rates in all areas of child care, education and intervention and the paucity of preservice training programs, inservice or outreach training opportunities must be coordinated, interdisciplinary and immediate. Kontos (1992) presents convincing data that indicate inservice training and technical assistance result in improved child care, as well as a dramatically lower turnover rate for family care workers.

ACEI also recognizes the importance of including administrators in any personnel preparation system. Specific competencies related to integrated early care, education and intervention must be included in preservice and inservice leadership training programs. The extent to which education, care and intervention personnel employ integrated and collaborative practices is directly related to an administrator's ability to identify, nurture and reward such behaviors.

ACEI affirms the right of all infants,

toddlers and family members to child

care, education and intervention delivered

by trained personnel who have

appropriate certification and/or licenses

and who are adequately and

equitably compensated. One important step in establishing any field as a profession is some means to assess each individual's work performance and to license or credential those deemed competent according to criteria developed by the profession (Radomski, 1986). National surveys across fields, however, clearly indicate the lack of a credentialing or certification system that recognizes and monitors an individual's competency in the education, intervention or care of very young children. After completing a survey of child care regulations in the U.S., Phillips et al. (1990) concluded: Among the most disturbing findings in the state-by-state analysis is the lack of attention given to specialized training for child care providers. It is the rare state that requires both pre- and in-service training of center- or home-based staff; many more states fail to require either form of training. (p. 175)

Data reported by NAEYC (1988) indicate that only 24 states and the District of Columbia certify early childhood teachers as distinct from elementary teachers. Only three states define early childhood to be birth through age 8, as does ACEI. Furthermore, in a national survey of personnel standards for Part H of IDEA, Bruder, Klosowski and Daguio (1991) found that few regulatory standards were specific to personnel providing services to infants and toddlers.

ACEI recognizes the importance of formal licensing or credentialing of early childhood educators, care providers and early interventionists for at least two reasons. First, and most important, studies have consistently found developmentally appropriate practices are best predicted by the combination of an individual's formal education and training in child development/early childhood education and his/her exposure to supervised practical experiences (Fischer & Eheart, 1991; Snider & Fu, 1990). Evidence indicates that these same factors also affect the quality of services provided by early interventionists (Kontos & File, 1992).

Second, a credentialing or certification system based on national standards of care, education and intervention for all infants and toddlers, but flexible enough to accommodate the unique needs of different states, could focus the efforts of historically distinct fields to join forces and empower personnel. As Bredekamp (1992) observes: The most overwhelming barrier to all our work on behalf of children is always financial; we know that we must improve compensation to ensure that we attract and keep the best and brightest in our profession, but we have not figured out how to get the money. (p. 37)

Bellm, Breuning, Lombardi and Whitebook (1992) report that real earnings by child care teachers and family child care providers have actually decreased by nearly one-quarter since the mid-1970s. Historically, professionals have not organized around the issue of compensation, perhaps perpetuating the general perception that child care, education and intervention are basically unskilled labor and that anybody can "watch" children (Modigliani, 1988; Morin, 1989; Phillips et al., 1990). ACEI solicits the support and collaboration of other professional groups to help ensure an integrated system that recognizes and monitors the competencies of personnel via formal credentialing or certification and that equitably rewards individuals accordingly.


Recent efforts to develop a comprehensive system of intervention for infants and toddlers with special needs and their families have provided opportunities to examine service access and quality issues. The key question in formulating public policy, particularly under Part H of IDEA, is: Should we create or continue a segregated system for early intervention or should we focus on collaborative efforts to support and improve general child care and education systems? It is becoming clear that one inclusive child care and education system is needed. Moreover, a collaborative approach is required if needed special interventions are to be embedded within the system.

The building of such a system entails constructive attention to:

* ensuring access to services for all children

* developing and enforcing quality control assurance


* training personnel and administrators to meet

the needs of an extremely diverse population in

developmentally appropriate ways.

Such a system also requires public policies that provide resources to achieve

the collaboration necessary to improve child care and education. Such policies benefit all infants and toddlers and their families, as well as society in general. Now is the time for individuals and groups representing historically distinct areas to join forces with families and decision-makers in creating the best possible system of services and care for our youngest children--our most vulnerable, yet most valuable, resources.


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Author:Stricklin, Sarintha
Publication:Childhood Education
Date:Jan 1, 1993
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