The inclusion of children with a disability in child care: The influence of experience, training and attitudes of childcare staff (free full-text available)

Heather Mohay
Emma Reid

Queensland University of Technology

Seventy-seven directors of childcare centres and 77 childcare staff were surveyed about their training to work with children with a disability, experience with these children, attitudes to disability, inclusive practices and barriers to inclusion. General support was expressed for the inclusion of children with a disability in child care, especially if the disability was mild. Some disabilities, e.g. speech and language problems, were viewed more favourably than others, e.g. acquired brain damage. Training for working with children who have a disability was associated with positive attitudes toward people with a disability. Directors currently including children with a disability in their program had significantly more training and experience with such children than other directors, although there was no difference in attitude to disability. Training and experience appeared to increase feelings of control over the provision of services for children with a disability.

Keywords: Child care, inclusion, childhood disability, attitudes, training, experience

Introduction

The enactment of Federal anti-discrimination legislation (Commonwealth of Australia, 1992) and changes in community attitudes towards disability have led to increased involvement of people with disabilities in numerous aspects of community life. These changes, along with an increase in the number of mothers of children who have disabilities wishing to return to the work force, have created a growing demand for childcare placements for such children (Department of Family and Community Services, 2000). This has required childcare providers to adapt their practices to meet the needs of these children and enable them to participate in the everyday activities of childcare centres (Department of Families Youth and Community Care, 2000). Government funding is available to support the inclusion of children with disabilities in child care through the employment of additional staff, staff training and the purchase of resources (Department of Family and Community Services, 2002; 2005; O'Connor, O'Connor, Holt, Wilkes & Charnley, 1997). However, accessing these funds can be problematic (Llewellyn, Thompson & Fante, 2002).

The Queensland Child Care Strategic Plan 2000-2005 (Department of Families Youth and Community Care, 2000) acknowledged the difficulties frequently experienced by families of children with a disability accessing appropriate childcare programs, and designated the inclusion of such children in child care as a high priority area.

Background

Including children with a disability in early childhood programs sets a precedent for inclusion as the norm, and reduces the possibility of later prejudice and negative attitudes towards people with a disability (Pivak, McCormas & LaFlamme, 2002; Sindelar, 1995; Wolery et al., 1994). The practice of inclusion encourages children's awareness of individual differences (Buysse, Wesley, Keyes & Bailey, 1996) and the great diversity among people (Wolery et al., 1993). In addition, research has shown that young children with disabilities who have attended inclusive programs have more positive social interactions and behavioural outcomes than those in segregated programs (Buysse & Bailey, 1993). Guralnick (1994) reported that parents of children with and without disabilities shared positive attitudes towards inclusion as well as concerns regarding the quality of special assistance, the qualifications of staff, the demands on staff time and the possibility of peer rejection. Parents of children with a disability preferred inclusive settings for their children, believing that typically developing peers provide positive role models for social skills, language, and age-appropriate behaviour as well as possible friendship (Hanson et al., 2001; Miller et al., 1992; Odom, 2000).

Most of the research literature also supports the beneficial nature of inclusion, but it is important to note that most studies were conducted in educational settings, particularly preschool and primary school environments. Little research relates to childcare settings, and most of what is available emanates from overseas, where childcare provisions are substantially different from those in Australia.

Australian child care

An array of childcare services exists in Australia, including, private and community-based long day care centres, family day care schemes, outside school hours and vacation care services, and occasional care services (Department of Family and Community Services, 2000). Approximately three per cent of children accessing child care in Australia were reported to have disabilities (Department of Family and Community Services, 2000). The largest proportion of these children was reported to be attending family day care, with decreasing percentages at community-based long day care centres and private childcare centres.

According to demographic data, three to four per cent of children aged zero to four years have a disability (Australian Bureau of Statistics, 1998; 1999; Disability Services Queensland, 1999), but this is probably an underestimate as many children with mild disabilities are likely to have been unrecorded. It therefore seems likely that children with a disability are under-represented in childcare centres.

Barriers to inclusion

The literature has not only highlighted the importance and benefits of inclusion but has also identified numerous barriers which have to be overcome for this to be successful. These include negative attitudes of the major stakeholders (Bricker, 1995; Wolery et al., 1994), poor staff-to-child ratios and insufficient staff support (Fleming, 1992; O'Connor et al., 1997; Wolery et al., 1994), lack of available places (Hanson et al., 2001), limited access to resources and equipment, inadequate staff training and experience in working with children who have a disability (Buysse et al., 1996; Dinnebeil, McInerney, Fox & Juchartz-Pendry, 1998; Pivak et al., 2002; Praisner, 2003), and difficulty accessing supplementary funding (Llewellyn et al., 2002). The type and severity of the disability may also affect the likelihood of a child being included in an early childhood program, with childcare centres more readily accommodating higher functioning children with milder disabilities such as speech and language delay, than those with severe disabilities (Buysse, Bailey, Smith & Simeonsson, 1994; Llewellyn et al., 2002; Stoiber, Gettinger & Goetz, 1998). Buysse et al. (1996) found that the discomfort level of childcare workers increased as the severity of the disability increased, and Cook (2001) reported that teachers tended to have more negative attitudes about severe disabilities.

Experience

Teachers' feelings of discomfort and negative attitudes towards children with a severe disability have been found to decrease after working with these children for a time (Giangreco, 1996; Horne, 1988). Similarly, childcare providers who had previous experience working with children with special needs tended to show greater confidence and interest in working with them in the future (Buell, Gamel-McCormick & Hallam, 1999; Dinnebeil et al., 1998) although in the Buell et al. study 40 per cent of respondents expressed a reluctance to work again with children who have a disability. Attitudes towards future work with children with a disability is likely to be influenced by whether previous experience was positive or negative (Praisner, 2003).

Training

Parents of children with a disability hold fears about the ability of childcare staff to meet the special needs of their children (Odom, 2000), and staff themselves also harbour doubts about their abilities and believe that more training would be beneficial (Fleming, 1992). The greater the amount of training and experience childcare practitioners have in the area of childhood disability, the more positive are their beliefs regarding inclusion (Miller & Cordova, 2002; Stoiber et al., 1998; Westwood, 1984) and the more likely they are to be willing to work with children who have a disability (Buell et al. 1999). These positive attitudes towards such children, gained through training and experience, can also enable childcare providers to promote similar attitudes in the children they work with and their parents (Bricker, 1995).

Attitudes

Negative attitudes of key stakeholders, such as parents, care providers, policy-makers, and special education teachers can be substantial barriers to the inclusion of children with disabilities in early childhood programs (Bricker, 1995; Eiserman, Shisler & Healey, 1995).

McGuire (1985) defined attitudes as ‘orientations that locate objects of thought (in this case disability or the concept of inclusion) on dimensions of judgement' (i.e. favourable or unfavourable evaluations). Attitudes have three components: a cognitive component made up of beliefs based on past experience; an affective component consisting of the feelings aroused; and a behavioural component or predisposition to act in certain ways. Attitudes are not innate; they are learned mainly as the result of direct experience or via interaction with others. Through the socialisation process, attitudes which are common to a social group are transmitted to its members. Attitudes may predict behaviour; however, actions are tempered by perceived social pressure at the time (Ajzen, 1991; Ajzen & Fishbein, 1980). Applying this to a childcare setting, a centre director may have positive attitudes to including children with disabilities in child care as a result of their previous experience and training, the beliefs of the social group to which they belong, and the emotions aroused by childhood disability. However, whether or not children who have a disability are actually enrolled in the program will depend not only on the director's attitude but also on the attitudes of other stakeholders such as parents, staff and government officials, and the resources available. For inclusion to be successful it is essential for all involved to hold positive and productive attitudes toward disability in general and towards children who have a disability in particular (Bricker, 1995).

Significance of current research

The dearth of relevant Australian research to guide planning and decision-making regarding the provision of appropriate child care for children with disabilities has been identified in a number of documents (Department of Families, Youth and Community Care, 2000; Mohay & Woodhouse, 2000). The present study examined the relationship between training and past experience of childcare staff and their attitudes to disability, and the influence of training, experience and attitudes on the practice of including children with a disability in childcare centres in a metropolitan area of Brisbane. Participants' opinions about other factors influencing successful inclusion of such children in their programs were also sought.

Queensland University of Technology Human Research Ethics Committee granted ethical approval for the project.

Method

Participants

Letters were sent to all 128 childcare centres in the south metropolitan area of Brisbane, inviting the directors, and a staff member currently working in direct contact with children, to participate in the study. Seventy-seven centres (60%) volunteered to participate. Their locations represented a wide range of socio-economic areas (Australian Bureau of Statistics, 2002). Sixty-eight per cent of the centres had children with a disability currently enrolled and a further 15 per cent had enrolled such children in the past. Children with a disability represented 1.76 per cent of the total number of children enrolled in the centres surveyed, with between one and eight (Mean=1.77) children with a disability being enrolled in a centre.

Seventy-seven centre directors and 77 staff members (including group leaders, assistants, and assistant directors) participated. There were 153 female and one male respondents with an age range of 19 to 62 years (Mean=33 years). Participants had been in their current position from two days to 20 years (Mean=3.42 years) and had worked in child care from nine months to 35 years (Mean=9.93 years). Twenty-two (22) participants (14 centre directors and eight childcare staff) were excluded from statistical analyses because of incomplete questionnaire data, leaving a total of 132 respondents.

Materials

Information sheets outlining the objectives of the research, questionnaires and consent forms were delivered to each participating centre and returned anonymously to the researchers. Each participant received a four-page, three-part questionnaire.

Part 1 requested information regarding the participant's age, gender, the position they were employed in at the childcare centre, the length of time they had been working in their current position, and the total length of time they had worked in child care.

Part 2 was the Interaction with Disabled Persons (IDP) Scale (Gething & Wheeler, 1992). This scale was designed and standardised in Australia to measure the level of discomfort experienced when interacting with people with disabilities. The IDP consists of 20 items which tap the three theoretical components of attitude to disability, i.e. beliefs, affect, and behaviour (Gething, 1994). Each item on the IDP is rated on a six-point Likert scale ranging from ‘I disagree very much' to ‘I agree very much'. The possible range of scores is therefore 20-120, the higher scores indicating greater discomfort during social interactions with a person with a disability.

Part 3 sought information on current and past inclusion of children with disabilities in the participating centres, the extent and satisfaction of respondents' current and past experience working with children with disabilities; their willingness to work with similar children in the future; and the amount and type of relevant training they had received. Participants were also asked what support services (if any) they were currently accessing, and what (if any) additional resources and/or training they felt they required to enable them to successfully include children with a disability in their programs.

A score for experience working with children with a disability was obtained by adding together the self-rating scores on three questions related to experience: 1) amount of experience working with children with a disability (1='no experience' to 5=‘extensive experience'); 2) the number of children with a disability the participant had worked with throughout their career(1=‘none' to 5=‘10 or more'); and 3) the total amount of contact time spent working with children with a disability during the participant's entire career (1=‘less than 1 week' to 5=‘more than 24 weeks'). The score for experience working with children with a disability could therefore range from three to 15, with higher scores indicating greater amounts of experience.

A score for the amount of training to work with children with a disability was based on the sum of ratings on two questions: 1) the number of training experiences including hands-on training, seminars, workshops and formal university courses; and 2) the total amount of training in hours. Each question was scored on a five-point scale so that scores for training to work with children with a disability could range from two to 10, with higher scores indicating greater amounts of training.

For the purpose of this study (as in most previous studies) disability was not defined. Responses therefore depended on the subjective definition held by respondents. However, a fairly broad list of disabilities was provided for people to respond to in terms of previous experience and attitude to inclusion. This may have influenced the definition adopted by participants in responding to other components of the survey.

Results

Data from centre directors and childcare staff was used to calculate correlation coefficients between IDP score, age, experience and training. The results are displayed in Table 1. Age was not associated with either IDP score or amount of training but showed a small, statistically significant, correlation with amount of experience working with children with a disability.

Table 1. Inter-correlations between IDP score, age, experience and training for working with children with a disability
Variables IDP score Age Experience Training
1. IDP score - -.04 -.025** -.36**
2. Age - .27** .14
3. Experience - .57**
4. Training -

NOTE: *p < .05; **p < .01

Experience and training were significantly correlated and both were significantly negatively correlated with IDP total score (i.e. more training and more experience were associated with more positive attitudes to disability). However, all of these associations, although statistically significant, were quite low and regression analysis indicated that age, amount of experience working with children with a disability, and amount of training for working with children with a disability accounted for only 11 per cent of the variation in scores on the IDP scale. Most of this (7%) was contributed by amount of training.

Analysis of variance (ANOVA) was used to assess the differences in attitudes, experience and training of directors who currently included children with a disability in their centre and those who did not. Only data from directors was utilised to avoid breaching the independence of observations and also because the decisions of directors determine whether or not children with disabilities will be included in their centre. The results of these analyses are presented in Table 2.

Table 2. Differences between mean IDP, experience and training scores of directors who currently included children with a disability in their centre and those who did not
Current inclusion
Yes
(N=45)
No
(N=18)
F p
Mean IDP score 61.82 (sd 10.34) 62.89(sd 14.14) 0.11 NS
Mean experience score 12.96 (sd 3.75) 9.93 (sd 2.73) 10.24 <.01
Mean training score 6.31 (sd 1.83) 4.78 (sd 2.02) 8.51 <.01

No significant difference was found between the IDP scores of centre directors who currently included children with disabilities in their program and those who did not, although the former had slightly lower (more positive) scores than the latter. Directors of centres currently including children with disabilities did, however, have significantly higher scores for both experience and training in the area of disability.

Of the respondents who completed the survey, 44 per cent were currently working daily, or at least weekly, in direct contact with up to eight children with a disability. All but eight participants (6%) indicated that children with disabilities should be included in child care; however, 20 per cent indicated that this should be restricted to children with mild disabilities, and only 20 per cent were willing to include children with severe disabilities. Table 3 shows the percentage of participants who had at some time in their career experienced working with children with different disabilities, the positive/negative feelings (valence) associated with that experience, and the percentage of all respondents expressing willingness to work in the future with children with different types and degrees of disability.

Table 3. Childcare providers' experience, quality of experience and willingness to work with varying types and degrees of disability
Type of disability Experience (%) Valence of experience (%)1 Willing to work with children
with specific type and degrees
of disability in the future (%)2
Positive Negative Both Mild Mod Severe Total
Hearing impairment 64.3 97 1 2 11 44.8 40.9 96.7
Visual impairment 40.9 95 3.4 1.6 18.8 39.6 24 82.4
Physical disability 69.5 90.3 3.8 5.9 20.8 45.5 18.8 85.1
Speech/language problems 81.2 93.1 1.7 5.2 7.1 43.5 44.2 94.8
Neurological disorder 43.5 87.4 6.3 6.3 18.2 35.7 23.4 77.3
Behaviour problems 78.6 51 30 19 20.8 51.3 13.6 85.7
Autism Spectrum Disorder 66.2 76 7 17 20.1 44.2 17.5 81.8
Chronic illness 48.1 93 4 3 9.1 41.6 26.6 77.3
Acquired brain injury 13.6 70 15 15 19.5 26 9.7 55.2
Developmental delay 68.8 92 3 5 13.6 47.4 27.9 89
Intellectual impairment 48.7 89 7 4 16.2 39.6 24 79.9

NOTE: 1 Only participants with previous experience of specific disabilities included.
2 All participants included. Percentages indicate the severest degree of disability participants were willing to work with.

More than 80 per cent of participants reported having experience working with children with speech and/or language problems, while only 13.6 per cent reported working with children with acquired brain injury. Most people reported that their experiences working with children with disabilities had been positive, although feelings about working with children with behaviour problems and those with brain injury were more mixed. The majority of participants expressed a willingness to work with children with all the disabilities nominated; however, most people indicated that the disabilities should be mild or moderate. Almost all participants were willing to work with children with hearing impairment or speech and language disorders, and over 40 per cent indicated that they would work with these children even if the disability were severe. At the other extreme, only 55 per cent of participants indicated a willingness to work with children who had acquired brain damage.

Extra staff and more training were the most frequently cited forms of additional assistance required for the successful inclusion of children with disabilities in childcare, followed by special equipment, increased information, and regular support from allied health professionals.

Discussion

This study aimed to investigate the relationship between attitudes to disability, training and experience and the influence of each of these variables on the enrolment in child care of children with disabilities. The results may paint a rather rosy picture, as only 60 per cent of the centres approached agreed to participate in the study, and a further 14 per cent were excluded because of incomplete information. Of the centres who participated in the study 83 per cent had included children with disabilities in their program at some time. It therefore seems likely that there was a bias towards participants with more positive attitudes towards disability and more training and experience in the area of childhood disability. Furthermore, all the centres were in a Brisbane metropolitan area; hence the applicability of the results to other states or to rural areas is questionable. An additional weakness in the study is the fact that it was unclear whether the children identified as having a disability included only those with a diagnosed disorder or whether the identification was based on the respondents' opinions. It therefore seems likely that the number of children with disabilities was overestimated and that a disproportionate number of children with mild disabilities were included. Despite these shortcomings the results provide some interesting insights into factors influencing the inclusion in child care of children with disabilities.

Scores on the IDP were in the middle range, indicating neither very positive nor very negative attitudes to disability. More positive attitudes were associated with greater amounts of training for working with children with a disability, although training accounted for only seven per cent of the variance in attitude scores. Childcare centre directors who had children with disabilities enrolled in their program had more training for working with these children than those who did not. These findings are consistent with those of Miller and Cordova (2002) and Shade and Stewart (2001) who also reported that training for working with children with a disability could engender more positive attitudes toward people with a disability. Lee and Rodda (1994) stressed the importance of providing accurate information about disability in order to improve attitudes in those working with people with a disability and in the wider community. In the present study 11 per cent of respondents reported that they had received no training to prepare them for working with children with disabilities. Most of the others reported that they had some training, most frequently in the form of seminars or workshops, with fewer attending formal university courses or receiving hands-on training. A small minority (6.5%) mentioned that they used sources such as the Internet or books to gain information. However, only 25 per cent of respondents rated their training as adequate and 60 per cent stated that they were not really confident in their ability to include children with a disability in their program. Additional training, particularly in-service training, was cited as one of the major forms of assistance required to facilitate the inclusion of children with a disability in childcare programs. General training in principles for the inclusion of such children can be provided by various courses, but training and practice need to be closely linked. Kilgallon and Maloney (2003) reported that teachers acquired information about disability on a ‘need to know' basis, i.e. when they had a child with a disability in their classroom. It would therefore seem that the most appropriate and effective training would be provided on-site, at the time of the child's enrolment and directed at the specific needs of the child. Wesley (1994) described one such consultation program in the US in which relevant allied health professionals and special education teachers were available to provide on-site training for childcare staff when a child with a disability was enrolled in their program. The Australian Supplementary Services Program (SUPS) (Department of Family and Community Services, 2005) is also intended to provide this type of support, and O'Connor et al. (1997) reported that SUPS workers played an important role in the process of inclusion. Llewellyn et al. (2002) also saw the value of SUPS but reported that it could be difficult to access and was frequently used to provide input to the child rather than training for the staff. Nevertheless almost all of the childcare centres in the present study which had children with a disability enrolled were receiving some government support, in the form of the Supplementary Services Program or the Special Needs Subsidy Scheme (SNSS) (see endnote).

Amount of experience working with children with a disability was also associated with attitudes to disability but explained less than five per cent of the variance in scores on the IDP. Nonetheless, centre directors who had children with disabilities enrolled in their program had significantly more experience than those who did not. Thus, while experience may influence attitude to disability, it may have an even greater influence on behaviour, possibly by affecting how confident the person feels about being able to work with a child with a disability. In the present study most of the participants who had worked with children with disabilities stated that this was a positive experience. It is noteworthy that the highest number of participants reported a willingness to work with children with impaired hearing or speech and/or language problems (the disabilities with which the highest number of participants had previous positive experience), and the lowest number were willing to work with children with acquired brain injury (the disorder with which the fewest participants had previous positive experience). It is therefore important to recognise that lack of experience or unpleasant experiences may lead to negative attitudes. However, this was not always the case, as even though a significant percentage of participants reported negative experiences working with children with behaviour problems, this did not appear to adversely affect their willingness to work with these children in the future.

No difference was found between the attitudes of centre directors who currently included children with disabilities in their program and those who did not. This may reflect the biased nature of the sample, i.e. it is possible that only those directors with positive attitudes to disability volunteered to take part in the study. However, directors of childcare centres who currently included children with a disability had significantly greater amounts of training and experience in working with such children. Thus, although the two groups of directors had similar attitude scores, they may, as a result of different levels of training and experience, have differed in their perceived behavioural control (Ajzen, 1991) over the inclusion of children with a disability. For example as the result of their increased training and experience, directors who currently included such children in their programs may have been more confident about their ability to provide for these children and may have had the appropriate measures in place, such as staff, resources, materials or space etc., to support inclusive practices.

In addition to seeking further training, participants identified the need for extra staff to support the successful inclusion of children with disabilities in childcare programs. Buysse, Wesley and Keyes (1998), in the United States, identified inadequate staff–child ratios and training as among the most significant barriers to such inclusion. Similar findings were also reported from a 1992 survey of childcare centres in the Brisbane North Region (Fleming, 1992). These problems therefore seem to be universal and long-standing, and it is not clear how much improvement is occurring in these areas in order to facilitate more comprehensive inclusion of children with disabilities in childcare programs.

Participants in the present study also nominated the need for additional resources, such as books, equipment and support from specialist allied health and special education professionals, and noted the difficulties in accessing these resources because of the often decentralised and fragmented nature of the services available. This confirms the findings of Mohay and Woodhouse (2000) that more coordinated and integrated health, education and childcare services would help to promote inclusion in early childhood programs.

Conclusion

In general the childcare professionals surveyed supported the inclusion of children with disabilities in long day care programs, particularly if these children had only mild/moderate disabilities. Training and experience were both found to be weakly associated with more positive attitudes to disability, and both influenced the likelihood of children with disabilities being enrolled in childcare programs. Increased training and experience appear to go hand-in-hand and to have the effect of raising the confidence of centre directors and staff about their ability to provide a suitable program for children with disabilities.

Childcare centres are legally required to accept children with a disability into their programs; however, without adequate numbers of experienced and well-trained staff, and appropriate resources, equipment and support, they may not be able to provide programs which are beneficial to the child. While laws and policies which uphold the rights of people with a disability are to be commended, legislators and policy-makers have an obligation to ensure adequate resources are available to enable them to be put into practice.The findings of the present survey suggest that it is not negative attitudes that limit the inclusion of children with a disability in long day care centres, but rather a lack of confidence about having the skills and resources to provide an appropriate program. This situation could be at least partly remedied by providing appropriate training for childcare personnel. This could take the form of seminars and workshops, but programs which combine training and experience such as on-site training and secondments of staff to other centres where children with disabilities are successfully included are likely to be more effective (Wesley, 1994).

Endnote

From the beginning of 2006 the SUPS program has been incorporated into the Inclusion and Professional Support Program (IPSP) (Department of Family and Community Services, 2005). The SNSS program still exists but will be changed to the Inclusion Support Subsidy in July 2006.

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