Navy CYP Inclusion Guidebook

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Navy CYP Inclusion Guidebook

  1. 1. Navy CYP Inclusion Guidebook Guidance for Working With Children With and Without Disabilities July 2010 Developed by Kids Included Together for Navy Child and Youth Programs
  2. 2. Navy CYP Inclusion Guidebook i Table of Contents I. Inclusion in Navy Child and Youth Program (CYP)..................................................... 1 1. Philosophy............................................................................................................... 1 2. Benefits of Inclusion............................................................................................... 1 3. Elements of Inclusive Programs ............................................................................. 2 4. Understanding the Law........................................................................................... 2 4.1 Section 504 of the Rehabilitation Act......................................................... 2 4.2 Americans with Disabilities Act................................................................. 4 4.3 Defining Disability...................................................................................... 4 4.4 Major Life Activities................................................................................... 5 5. Additional Resources.............................................................................................. 5 II. Intake and Enrollment ..................................................................................................... 6 1. Intake Process ......................................................................................................... 6 1.1 Placement.................................................................................................... 6 1.2 Accommodations and Supports .................................................................. 7 1.3 Auxiliary Aides and Services...................................................................... 8 1.4 Emergency Action Plan .............................................................................. 8 2. Confidentiality ........................................................................................................ 9 III. Navy CYP Inclusion Support Systems.......................................................................... 10 1. Inclusion Action Team.......................................................................................... 10 1.1 IAT Team Structure.................................................................................. 10 1.2 Identifying IAT Resources for CYP Professionals and Families ............. 13 2. Referral Process .................................................................................................... 15 3. Inclusion Helpline................................................................................................. 17 3.1 Areas of Support ....................................................................................... 18 3.2 Sample Calls and Recommendations........................................................ 18 3.3 Follow-up.................................................................................................. 19 IV. Accommodations............................................................................................................. 21 1. Definition.............................................................................................................. 21 2. Types of Accommodations ................................................................................... 21 3. Examples of Accommodations ............................................................................. 22 3.1 Policies...................................................................................................... 22 3.2 Practices.................................................................................................... 22 3.3 Procedures................................................................................................. 23 3.4 Staffing...................................................................................................... 23
  3. 3. Navy CYP Inclusion Guidebook ii 3.5 Environment.............................................................................................. 24 3.6 Routine...................................................................................................... 24 3.7 Activities and Materials............................................................................ 25 4. Principles of Accommodations............................................................................. 25 5. Accommodations Versus Exceptions ................................................................... 26 6. Resources.............................................................................................................. 27 V. Disabilities and Special Needs........................................................................................ 28 1. Categories of Disability ........................................................................................ 28 1.1 Physical..................................................................................................... 28 1.2 Sensory...................................................................................................... 29 1.3 Speech and Language ............................................................................... 30 1.4 Developmental.......................................................................................... 31 1.5 Chronic Health Conditions ....................................................................... 32 1.6 Social-Emotional Disorders...................................................................... 33 1.7 Learning and Attention ............................................................................. 34 2. Children with Special Needs................................................................................. 35 3. Additional Resources............................................................................................ 36 VI. Behavior Support............................................................................................................ 37 1. Understanding Behavior ....................................................................................... 37 1.1 Temperament ............................................................................................ 38 1.2 Deployment............................................................................................... 39 1.3 Activities................................................................................................... 39 1.4 People........................................................................................................ 40 1.5 Environment.............................................................................................. 40 1.6 Physiological States .................................................................................. 41 2. CYP Behavior Support Policy .............................................................................. 42 2.1 Determining the Purpose of the Behavior................................................. 42 2.2 Identifying Strategies for Accommodations............................................. 44 2.3 Identify Teaching Strategies ..................................................................... 45 2.4 Outline Appropriate Responses and Consequences.................................. 45 2.5 Developing a Behavior Plan ..................................................................... 49 3. Supporting Positive Behavior ............................................................................... 50 3.1 Schedules .................................................................................................. 50 3.2 Transitions................................................................................................. 51 3.3 Setting Up the Environment...................................................................... 52 4. Additional Resources............................................................................................ 53
  4. 4. Navy CYP Inclusion Guidebook iii VII. Partnering with Families................................................................................................ 54 1. Understanding Families ........................................................................................ 54 1.1 Concerns of Families with Children with Disabilities.............................. 55 1.2 The Role of Culture .................................................................................. 55 2. Communication with Families.............................................................................. 56 2.1 What CYP Professionals Need to Know .................................................. 57 2.2 Sharing Concerns...................................................................................... 59 2.3 Establishing Open Communication .......................................................... 61 3. Additional Resources............................................................................................ 62 Appendix A: Sample Emergency Action Plan......................................................................... 63 Appendix B: Inclusion Support Referral Form...................................................................... 67 Appendix C: Sample IAT Support Plan.................................................................................. 69 Appendix D: Environment Checklists ..................................................................................... 73
  5. 5. Navy CYP Inclusion Guidebook iv
  6. 6. Navy CYP Inclusion Guidebook 1 I. Inclusion in Navy Child and Youth Program (CYP) The following guidebook provides guidance to Navy CYP Professionals on the policies and standards in including children with disabilities and other special needs in Navy Child and Youth Programs. CNIC regulations and policies in the guidebook must be adhered to in order to meet standard requirements. In addition, guidance and assistance is provided in order to assist Navy programs in supporting all children, regardless of ability or need, in Navy CYP. 1. Philosophy Inclusion is an attitude and a philosophy that welcomes and supports all children. Inclusion is a belief in every person’s inherent right to participate fully in society. Inclusion conveys the idea that we appreciate each child, that we see each child’s gifts, and that we value children of all abilities being together. Inclusive programs are communities where children with and without disabilities live, learn, and play together. The goal of inclusion in Navy CYP is to support the participation of children with and without disabilities in child and youth activities and programs. Children with and without disabilities are respected as contributing members and participate in all aspects of Navy CYP. CYP professionals make respectful accommodations so that all children can be successful in Navy child development centers, child development homes, school age care, and youth and teen programs. 2. Benefits of Inclusion One of the major misconceptions about inclusion is that it only benefits the children with disabilities. Although children with disabilities do benefit, youth without disabilities, parents, agencies, and the community all benefit from inclusion. Youth with and without disabilities make new friends, have the opportunity to learn from peer models, build independence and coping skills, notice similarities and differences amongst their peers, develop interpersonal skills, and learn to accept others. Inclusive programs where children with and without disabilities play and interact together lead to the understanding of and acceptance of differences. Programs that promote inclusive practices model an appreciation of ability difference as a form of diversity. These benefits have an impact
  7. 7. Navy CYP Inclusion Guidebook 2 on the greater society, as children in inclusive environments grow up viewing disability as a natural part of life. Access to inclusive child care enables parents to work, gives them the opportunity for respite, helps them learn to accept their child’s strengths and challenges, allows them to share typical parenting experiences and develop relationships with other families. Navy CYPs benefit from inclusion by developing networks of professional services and community resources and an overall awareness of how to support individual strengths and needs. CYP professionals who learn to make accommodations for children as they need them develop their skills as youth development professionals. The community benefits from having settings that encourage understanding, flexibility, and acceptance of differences. 3. Elements of Inclusive Programs Elements of inclusive programs include the following items: • Policies, practices, and procedures that support the participation of children with and without disabilities or other special needs. • Accommodations to support the ability of all children to play, learn, socialize and participate in daily routines and activities. • Modifications to materials, activities, and the environment to accommodate the needs of all children. • Behavior support strategies to help children meet expectations and learn appropriate behavior. • Partnerships with families and ongoing interpersonal communication. • Adult to child ratios that support child and program needs. • Training and support for child and youth professionals to increase knowledge and skills. 4. Understanding the Law In addition to understanding the philosophy of inclusion and its benefits, CYP professionals must also understand the laws that protect the rights of individuals with disabilities and their families. Since the Navy is a federal agency, both the Rehabilitation Act of 1973 (RA 1973) and the Americans with Disabilities Act of 1990 (ADA 1990) apply to Navy Child and Youth Programs. 4.1 Section 504 of the Rehabilitation Act Section 504 of the RA 1973 is a national law that states that “no qualified individual with a disability in the United States shall be excluded from, denied the benefits of, or be subjected to discrimination under" any program or activity that either receives Federal funding or is
  8. 8. Navy CYP Inclusion Guidebook 3 conducted by any Executive agency. Section 504 is an anti-discrimination, civil rights law that requires that the needs of children with disabilities be met as adequately as the needs of children without disabilities in federally funded programs. Under Section 504, Navy CYP cannot exclude or deny children and youth with disabilities an equal opportunity to receive program benefits and services. Prohibitions against discrimination apply to CYP service availability, accessibility, delivery, and CYP administrative activities and responsibilities. Title 45: Part 84 Under Title 45: Part 84, nondiscrimination on the basis of disability in programs or activities receiving federal financial assistance, a CYP cannot: • Deny a qualified child or youth the opportunity to participate in or benefit from CYP. • Provide a child with a disability an opportunity to participate in CYP that is not equal to the opportunity of others. • Provide different or separate programs to children with disabilities unless such action is necessary to provide services that are as effective as those provided to others. • Otherwise limit a child with a disability in the enjoyment of any right, privilege, advantage, or opportunity enjoyed by other children and youth in CYP. Navy CYP is not required to produce the same level of achievement for children with and without disabilities. However, CYP must provide children with disabilities an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement, in the most integrated setting appropriate to the child’s needs. §84.37 Nonacademic Services Navy CYP must provide extracurricular services and activities in such a manner as is necessary to afford children with disabilities equal opportunity for participation in such services and activities. Nonacademic and extracurricular services and activities may include sport and fitness programs, transportation, special interest groups or clubs. In providing sport and fitness programs, CYP may not discriminate on the basis of disability. Any sport or fitness program must provide qualified children with disabilities (those children who meet basic age and eligibility requirements) an equal opportunity for participation. §84.38 Preschool Any program that receives federal funding or is conducted by a federal agency that provides preschool education or day care may not, on the basis of disability, exclude qualified children with disabilities and shall take into account the needs of such children in determining the aids, benefits, or services to be provided.
  9. 9. Navy CYP Inclusion Guidebook 4 4.2 Americans with Disabilities Act The ADA 1990 is a federal civil rights law that prohibits discrimination against individuals with disabilities and their families. The ADA is divided into sections, referred to as titles. Title II is the legislation that pertains to government agencies. Title II requires that government agencies conduct case-by-case assessments of what an individual with a disability needs to be fully included in government programs. Title II guarantees equal opportunities for individuals with disabilities Navy Child and Youth Programs. The ADA outlines four primary types of accommodations: • Inclusive admissions policies that do not tend to screen out children with disabilities. • Changes to organizational policies, practices and procedures. • Auxiliary aids and services to ensure communication. • Removal of physical barriers in program facilities. 4.3 Defining Disability The definition of disability is broad and includes all types of conditions. Section 504 of the RA and the ADA legally define it in this way: An individual with a disability is a person who: • Has a physical or mental impairment that substantially limits one or more major life activities. • Has a record of such an impairment. • Is perceived as having such an impairment. Physical or mental impairments are further defined as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as an intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disabilities (US Department of Education Office of Civil Rights). The ADA provides guidance on the meaning of “substantially limits” as significantly restricted as to the condition, manner, or duration under which an individual can perform a major life activity when compared to the condition, manner, or duration under which the average person in the general population can perform the same major life activity.
  10. 10. Navy CYP Inclusion Guidebook 5 4.4 Major Life Activities Major life activities include but are not limited to caring for one’s self, speaking, hearing, seeing, walking, standing, breathing, reading, concentrating, thinking, communicating, and working. In a CYP, examples of major life activities include using the bathroom independently, communicating with other children and CYP professionals, understanding directions, learning the program routine, playing, and making friends. 5. Additional Resources • For information and resources on how the law applies to child care settings, visit the Child Care Law Center at www.childcarelaw.org. • For information on Section 504 obligations, visit the US Department of Education Office of Civil Rights at www.ed.gov/about/offices/list/ocr/index.html. • For general information on disability rights, visit the US Department of Justice website at www.usdoj.gov. • Read the Electronic Code of Federal Regulations (e-CFR) at GPO Access, a Service of the US Government Printing Office at www.gpoaccess.gov.
  11. 11. Navy CYP Inclusion Guidebook 6 II. Intake and Enrollment A family’s first contact with CYP will set the stage for the family-CYP professional relationship throughout the child’s participation in the program. The intake and enrollment process allows both the family and the professionals to learn about what the child may need to be successful in a child, youth, or teen program. It gives the family the opportunity to learn about CYP policies and procedures. It also provides an opportunity for CYP professionals to share their philosophy on inclusion and how they support children with and without disabilities in their programs. This chapter outlines the CYP intake process and enrollment procedures and strategies for maintaining confidentiality. 1. Intake Process No child who meets the basic age and eligibility requirements may, solely based on disability or special need, be excluded from Navy CYP. All families will complete the intake process for enrolling their child in Navy CYP. When families identify their child as having a disability, medical condition, or specific need, CYP professionals will work with the family to determine the following: • Placement in the most inclusive setting appropriate to the child’s needs. • Accommodations and supports for participation. • Auxiliary aides or services to ensure effective communication. • Emergency action plan for medical or other health-related concerns. • Method for ongoing communication between CYP and the family. The process of identifying what the child needs to be successful in CYP is ongoing and a child should not be denied enrollment pending the completion of the information gathering process. 1.1 Placement CYP professionals will work with the family to gather information on the types of environments that work well for the child in order to identify an appropriate placement. CYP professionals should not assume that a child with a disability should automatically be placed in a Child Development Home (CDH). A CDH may be the best fit for a child, but this determination must be made by examining the needs of the child, the preferences of the family, and the resources and supports available to the local CYP. A CDH may offer lower staff to child ratios and less environmental stimulation; however, the CDH may also have fewer resources available to meet
  12. 12. Navy CYP Inclusion Guidebook 7 the child’s needs. In addition to general questions about the child’s interests and abilities, it is recommended that the following questions be included to help identify an appropriate placement: • Does your child seem excited about new environments? • Does your child enjoy toys and objects with bright colors and visual effects or seem sensitive to bright and stimulating toys and environments (may close eyes frequently)? • Does your child like games and activities that make noise and enjoy making noise or seem sensitive or upset by certain sounds (may cover ears frequently)? • Does your child enjoy physical touch and a variety of textures or tend to avoid touching certain textures or types of touch (may dislike people touching face and head)? • Does your child enjoy jumping, running, and active play or does your child prefer quiet play? (For an older child, the question may be phrased as ‘does your child enjoy sports or prefer to play cards or other quieter activities)? These questions will provide information on how the child interacts with and reacts to different types of environments and materials, which may be helpful in looking at the environments in available placement options. It is important to also consider accommodations that could be made in each environment. For example, a child is sensitive to noise and prefers quiet play and an available pre-K classroom in a Child Development Center (CDC) has 24 children and tends to be loud and active. Possible accommodations include designating an area for active play, creating a quiet area, scheduling a balance of quiet and active activities, and offering alternative activities for small groups during active games and activities. 1.2 Accommodations and Supports Navy CYP is required to make reasonable accommodations to policies, practices, and procedures to support participation for children with and without disabilities. Accommodations are discussed in detail in Chapter 4; however, families can offer insight into the types of accommodations that may be necessary in supporting their child. Areas to focus on and sample questions to ask families to gather information on the accommodations needed are listed below: • Play behaviors: How does your child play? Does she play alone? With adults? With other children? • Physical development: How does your child move? Does he require any adaptive equipment or supports for using fine motor skills? • Emotional development: What does she do when she is upset? What helps to calm her down? • Social development: How does your child cope with changes in routines? How does she react when she has to move from one activity to another?
  13. 13. Navy CYP Inclusion Guidebook 8 • Self-help skills: Does he need assistance when using the toilet? Are there specific things that he needs help with (opening his lunch or blowing his nose)? • Sensory needs: Are there any particular sounds or smells that bother him? Does he mind being close to other children and people? • Goals: What goals do you have for your child in the program? 1.3 Auxiliary Aides and Services Navy CYP are required to provide auxiliary aids and services that are necessary to ensure equal access to the programs offered for children and youth with disabilities who have physical or mental impairments, such as vision, hearing, or speech impairments that substantially limit the ability to communicate. CYP professionals must work with the family to determine the level of support needed for effective communication. In many cases, more than one type of aide or service can support communication. Discovering how a child communicates and what he or she may need to support communication requires asking the following questions: • How does your child communicate? Does she use gestures, speech, sign language, pictures? • How do you and your family communicate with your child? Does your child communicate best when others use verbal language, sign language, pictures, other? • How does your child request what he wants? • What does your child do to indicate what he does not want? • What are some ways your child shares how she is feeling? • What types of supports can we put in place to make sure we can effectively communicate with your child and he can communicate effectively with us? 1.4 Emergency Action Plan All children with chronic health conditions participating in Navy CYP must have a written document outlining their healthcare and emergency plans or physician care plan. A sample emergency action plan from the Asthma and Allergy Foundation of America is included in Appendix A. The American Academy of Pediatrics recommends the following information be included in the plan: • Child’s needs. • Medication or procedures required during care. • Special dietary needs. • Transportation needs. • Possible problems, special precautions. • Pediatrician’s name. • Emergency plans and procedures (including who to contact).
  14. 14. Navy CYP Inclusion Guidebook 9 2. Confidentiality CYP professionals will only be able to gain a family’s trust if they can guarantee that all information shared about a child’s disability or special need will be kept confidential. Details about a child may only be given to staff members for whom the information is absolutely necessary. In order to share any information with community agencies or organizations outside of CYP and/or CYP contractors, written permission must be obtained from the parents. Each CYP shall develop a system that will protect confidential information and communicate that system to parents during the intake process. Systems for maintaining confidentiality should include the following: • Process for keeping all records, forms and other information about the child’s disability in a secure location (i.e. locked cabinet in the director’s office). • Designation of a discreet area (not visible to all children and families) to post allergies or other life threatening conditions where CYP professionals can easily access the information. • Training for staff on keeping information confidential during the program day and outside program hours. • Plan or sample response for staff when parents of children without disabilities ask questions about other children in the program. For example, “We maintain every child’s confidentiality in our program, and so I am sorry that I cannot answer your question or concern. You can be assured that we do everything possible to ensure that all children have a positive experience in our program.” Families should be notified that general information about their child may be shared with CYP contract organizations (i.e. Kids Included Together (KIT), the Inclusion Action Team (IAT), or Military Life and Family Consultants (MLFCs) in order to receive customized recommendations for accommodations and supports. CYP professionals working directly with the child should ask parents how they would like their child introduced to others and what information is okay to share (if any). The answer to this question will be different for every family. As CYP professionals respect the family’s right to privacy, the family will respect and value the CYP’s commitment to their family.
  15. 15. Navy CYP Inclusion Guidebook 10 III. Navy CYP Inclusion Support Systems Navy CYP is dedicated to supporting the inclusion of children with and without disabilities. Navy CYP also recognizes that CYP professionals need guidance and support in designing accommodations, interpreting and responding to behavior, and partnering with families. Each child and family will present a unique situation and will require a customized approach. The IAT and the Navy CYP Inclusion Helpline are supports for CYP professionals as they work to meet the needs of a diverse population of children and families. This chapter will describe the process for CYP professionals in accessing and maximizing support from IAT and the Inclusion Helpline. 1. Inclusion Action Team The purpose of the IAT is to support CYP professionals in accommodating the needs of children and youth in CYP and to assist the program in securing the necessary support and resources from the chain of command and CNIC. The process for referring children for IAT support is detailed in Section 2, Referral Process. 1.1 IAT Team Structure The Installation CYP Director or CYP Director designated with installation oversight responsibilities is responsible for assembling an IAT for their installation or coordinating with the region. Duties for assembling the IAT include identifying an appropriate IAT leader, recruiting members, and interim leadership of IAT as needed. IAT Leader Appropriate IAT leaders include Fleet & Family Services Program (FFSP) Directors, all installation CYP Directors, Resource and Referral Directors, Regional CYP Managers, Exceptional Family Members Program (EFMP) Managers and Navy medical professionals. Duties of the IAT leader include but are not limited to the following: • Recruiting IAT members. • Orienting IAT members to CYP policies and procedures. • Ensuring that all appropriate parties are present to assist the team in having a clear picture of the child’s needs.
  16. 16. Navy CYP Inclusion Guidebook 11 • Communication with members. • Coordinating schedule and agendas for meetings. • Managing meeting caseloads. • Facilitating the meetings. • Submitting IAT support plans, recommendations and meeting minutes to the commanding officer or designee. IAT Members IAT members may include professionals working in the field of child and youth development, early intervention, medicine, family support services, therapy, special and general education, or related fields. The number of IAT members will vary by region or installation according to the size of the installation, resources available, and community involvement. The structure of the team will depend on what works best for each installation. CYP professionals are encouraged to examine local resources, as well as resources available through the region when deciding which option will work best: an installation IAT or a regional IAT. The team must be comprised of members who have relative information about the child’s case and the perspective needed to assist the team in developing a plan to best include the child successfully in the program. Although the members will differ by region and installation, the following perspectives should be represented on the IAT. Perspectives may be presented in written form (i.e. recommended emergency action plan from a medical authority): • CYP Director. • Medical personnel such as navy medical or civilian pediatricians and nurse practitioners. • CYP professional who has objectively observed the child and can provide documentation (may be the child’s teacher, youth leader, training & curriculum specialist or other relevant position). • Family support services representative examples include MFLCs, FFSP representatives, EFMP managers, school counselors, or marriage and family therapists (MFTs) • School district representative possibilities include School Liaison Officers (SLOs), and general or special educators • Therapeutic specialist could include an occupational therapist (OT), speech therapist (ST), physical therapist (PT), certified therapeutic recreation specialist (CTRS), behavioral therapist or board certified behavior analyst (BCBA) • KIT inclusion specialist (as needed) that has been working with the CYP professionals to develop supports and accommodations for the child. KIT inclusion specialists will participate via phone.
  17. 17. Navy CYP Inclusion Guidebook 12 Depending on the region, some IAT leaders may want to consider recruiting several individuals from each perspective to account for scheduling conflicts and other logistical issues. The CYP professional perspective will vary by meeting, depending on the cases being presented. Some meetings may include several CYP professionals from different installations. IAT leaders are encouraged to develop their own guidelines on whether the CYP professionals must attend the entire meeting, call in to discuss the child they have observed, or attend for only the applicable portion of the IAT meeting. IAT leaders should schedule the date of the next IAT meeting before adjourning the meeting to maximize member participation and minimize scheduling conflicts. Parents or guardians of the children participating in CYP may attend the portion of the IAT meeting that applies to their child. Parent participation is not required and the IAT chairperson or helpline inclusion specialist may help the CYP professionals determine whether parent participation would be beneficial. If a parent does participate in their child’s discussion, he or she may not be present for the discussion of other children participating in CYP. It is critical that the IAT maintain the confidentiality of the children and families supported by the IAT. Some regions or installations may recruit a parent of a child with a disability to participate in their IAT. Although a parent IAT member may serve on the team, he or she cannot have a child currently enrolled in a CYP. IAT Responsibilities In order to support CYP professionals in accommodating the needs of children and youth in CYP, the IAT has the following responsibilities: • Identify the needs of the child within the CYP. • Recognize areas where accommodations and individualized supports are necessary. • Contribute to the design of individualized accommodations and supports. • Review emergency action plans and health management plans. • Make recommendations for behavior plans. • Collaborate with CYP professionals as they develop IAT Support Plans for each child- specific case. • Communicate IAT meeting minutes to the commanding officer or designee, which shall include summary information about the accommodations being provided in CYP (does not have to include the full IAT Support Plan for each child). • Assist CYP professionals in identifying local resources and services. • Recommend CNIC supports where appropriate (including requesting funding for additional staff to increase adult to child ratios). • Organize resources for CYP professionals and families.
  18. 18. Navy CYP Inclusion Guidebook 13 • Discuss inclusion-related issues within the region (i.e. physical access, community collaboration, staff training). • Follow-up on child-specific cases and inclusion-related topics in the region. IATs are not limited to the responsibilities above and may outline further responsibilities that address regional needs. IAT Support Plan An IAT Support Plan must be completed for each child-specific case presented at IAT meetings and kept in the child’s file. The support plan must include the following: • Information from IAT referral form. • Emailed list of recommendations from the inclusion specialist. • Outline of strategies and accommodations being implemented in the CYP. • Emergency action plan, health management plan or behavior plan (if applicable). • Description of how information will be shared with CYP professionals working directly with the child and any necessary training. • List of recommended resources for CYP professionals and the child’s family. • Outline of follow-up (i.e. how often CYP professionals will check in with the family, KIT Inclusion Helpline, IAT). A sample IAT Support Plan is included in Appendix C. 1.2 Identifying IAT Resources for CYP Professionals and Families Identifying local and regional resources for CYP professionals and families is a central role of the IAT. IAT members represent multiple perspectives and may be connected to different systems of support within the region or community. In working toward organizing resources, both military and community supports should be considered. Common agencies or systems to consider include the following: Military System Support • CNIC N91 provides support to Navy CY professionals and programs. CYP professionals can request funding for accommodations, training and additional staff as determined by the IAT. • The Navy’s FFSP supports sustained mission and Navy readiness. FFSP provides services to strengthen personal and family competencies to meet unique challenges of the military lifestyle. Services include deployment readiness, new parent support, transition assistance, relocation assistance, family advocacy, life skills, and clinical counseling.
  19. 19. Navy CYP Inclusion Guidebook 14 • The EFMP is designed to provide support to military family members with special needs. The EFMP is a multidisciplinary assignment tool that interfaces with other military and civilian agencies to provide comprehensive support to families. • The MFLC program uses licensed clinicians with Masters Degrees and at least five years experience in Social Work, Counseling, or related clinical discipline. Consultants are trained on military specific topics including basic orientation to the deployment cycle, military culture, the chain of command, and reporting requirements in accordance with the Army’s Family Advocacy Program. MFLCs also receive KIT training on inclusion within their first two weeks of service in CYP. • Educational and Developmental Intervention Services (EDIS) is an overseas program that works with and provides support for children from birth to 21 years, who experience developmental delays that restrict their ability to learn. EDIS provides a variety of options to help nurture a child’s development including physical, occupational and speech therapy, a social worker and a psychologist. Community Support • The Alliance for Technology Access (ATA) provides information and referrals on technology resources, outreach and public awareness, and training for professionals. The ATA website (www.ataccess.org) lists 40 assistive technology resource centers nationwide. • The Arc of the United States advocates for the rights and full participation of all children and adults with intellectual and developmental disabilities. Using a network of members and affiliated chapters, the Arc improves systems of supports and services; connects families; inspires communities and influences public policy (www.thearc.org). • Disability.gov is a federal website that provides easy access to comprehensive disability- related information and resources on programs, services, laws and regulations. • The National Council on Disability website (www.ncd.gov) offers resources that include links to local parent training and information centers and state vocational and rehabilitation centers. • National Disability Agencies: Many national disability organizations have local chapters in nearly every state. For example, the Autism Society of America (www.autism-society.org) and United Cerebral Palsy (www.ucp.org) have chapters in every state. • The National Federation for the Blind (www.nfb.org) improves the lives of people who are blind or have low vision through advocacy, education, research, technology, and programs encouraging independence and self-confidence and has affiliates in all 50 states. • National Association of Child Care Resource and Referral Agencies (NACCRRA): Local resource and referral agencies often offer free training to early childhood and school age child care providers and may have programs specific to supporting children with
  20. 20. Navy CYP Inclusion Guidebook 15 disabilities in childcare. Search for local resource and referral agencies online at www.naccrra.org. 2. Referral Process The IAT is structured to organize resources and develop strategies for supporting children with disabilities and other special needs in CYP. The referral process is designed to standardize IAT procedures, identify which children need the support of the IAT (regardless of whether they have a diagnosed disability or medical condition), and provide child-specific recommendations for CYP professionals. It may be difficult for the IAT to provide customized recommendations for a child who has not yet entered the program or is new to the program. Every child with a disability will need different types of support depending on their individual strengths, needs, and the CYP environment. The referral process will allow KIT inclusion specialists to provide initial support to CYP professionals in identifying needs and planning for accommodations (i.e. evaluating available placement options and suggesting environmental accommodations). The IAT will provide ongoing support to CYP professionals in designing individualized supports and evaluating supports and accommodations as the child’s needs change over time. Prior to referring children for IAT support, CYP professionals have a responsibility to approach the child’s family as the first line of support. The child’s family may be able to provide the information needed to support the child and design accommodations for participation in the program. The referral process should not replace conversations with parents or guardians regarding concerns about the child’s behavior or participation in the program. CYP professionals will follow a three-step referral process to refer children for inclusion support through KIT. The Inclusion Support and Referral Form (see Appendix B) and the Inclusion Referral Decision Tree (see Appendix B) will help CYP professionals in determining whether a child will need to be referred to KIT. When a child has a disability, special need or condition that results in limitations to major life activities (breathing, walking, talking, playing, etc.), the CYP Director is required to complete the Inclusion Support and Referral Form. Challenging behaviors that threaten the safety of the child or others qualify as a condition that limits the child’s major life activities. It is recommended that children who display aggressive behavior be referred to KIT. If a child has a life-threatening condition, the child’s case may proceed directly to the IAT with a copy of the referral form submitted to KIT. A life-threatening condition puts the child in danger of death during the program day without medication or treatment and an emergency action plan in place. Examples of life-threatening conditions include (but are not limited to) the following: • Cardiac/heart conditions.
  21. 21. Navy CYP Inclusion Guidebook 16 • Severe allergies (i.e. bees, peanuts, etc.). • Severe asthma. • Severe hemophilia. • Some seizure disorders. • Type I diabetes. • Any condition documented by a physician as putting the child in danger of serious injury or death during the program day. The three-step process for referrals is described below: • Step One: A child is identified as having a disability, special need or condition that limits major life activities and requires accommodations or supports to participate in the CYP. The CYP professional completes the Inclusion Support Information and Referral Form (see Appendix B). • Step Two: If all four of the answers under section 2 are NO, the form is placed in the child’s file. Ensure that any necessary documentation for children with medical needs is included in the file (i.e. medication administration form, emergency action plan) and kept in the child’s classroom or general program area for CYP professionals’ reference. If any of the answers under section 2 are YES, the CYP professional submits the form to KIT via email at navycyphelp@kitonline.org and continues to step three. • Step Three: The CYP professional follows recommendations from a KIT inclusion specialist: o Option 1: KIT recommendations without a referral to the IAT. A copy of the signed Inclusion Support Information and Referral form and recommendations must be kept in the child’s file along with any other necessary documentation. o Option 2: KIT recommendations with a referral to the IAT. A copy of the signed Inclusion Support Information and Referral form and recommendations must be kept in the child’s file and forwarded to the IAT chairperson to be included in the next IAT meeting agenda. Once a child has been referred to IAT, the IAT must meet within 30 days. If the condition is life-threatening or there is a question about the program’s ability to accommodate the child, the IAT meeting must be held as soon as possible. Once KIT receives a referral form, an inclusion specialist will contact the Navy CYP professional who made the referral to schedule a time to discuss the child’s case. CYP professionals may or may not need the support of IAT to include children with disabilities and other special needs. The inclusion specialist will help the CYP professional determine whether IAT support is needed and outline the supports and accommodations that are necessary for the child’s participation in CYP. The inclusion specialist will provide customized recommendations for CYP professionals on developing accommodations and support strategies and a recommendation for whether the child’s case should be presented to the IAT. The CYP
  22. 22. Navy CYP Inclusion Guidebook 17 professional will receive the customized recommendations and a signed recommendation for referral to the IAT via email. Some cases will not require a referral to KIT. For example, a child is identified by the parent as having a non-life threatening food allergy and does not eat dairy products. The CYP professional would complete the Inclusion Support Information and Referral form and maintain a copy in the child’s file. The program would follow the policies outlined in Chapter 4 of the OPNAV and post the child’s food allergy in a location viewable by staff that protects the child’s privacy and develop a plan for food substitutions if necessary. Many cases will require the support of the IAT. For example, a child is identified by the parent as having autism and the parents and CYP professionals are not sure what the child’s needs may be in the program. The inclusion specialist will work with the CYP professionals on gathering information from the family about the child’s strengths and needs. For a child with autism, the inclusion specialist might provide initial recommendations on structuring the program environment and routine and introducing the child to the routine and structure. The IAT will review the case at the next IAT meeting and identify where the child is doing well and where additional supports or accommodations may be necessary. The IAT will provide recommendations for CNIC support and community resources and the child’s case will be reviewed at IAT meetings on an ongoing basis as the child’s needs change. If the child is not initially recommended for IAT support, CYP professionals are responsible for making additional referrals as the child’s needs change. For example a child with asthma was not originally recommended for IAT support and begins to have an adverse reaction to his asthma medication. 3. Inclusion Helpline The Inclusion Helpline is staffed by inclusion specialists at KIT. CYP professionals can access the helpline via phone (866-930-0931) or email (navycyphelp@kitonline.org) and an inclusion specialist will respond during published hours. Any CYP professional can utilize the helpline, from operations clerks to CDH providers and regional staff, without going through the chain of command. The inclusion specialist will record information from the CYP professional including name, contact information, role and region. An individual may call the helpline to speak with an inclusion specialist or schedule a time for a group of individuals (i.e. center director, lead teacher, and teacher) to discuss a case or situation. Requests to speak with an inclusion specialist may also be made via the helpline email address. Overseas installations should email to schedule a time for a call that works for their time zone.
  23. 23. Navy CYP Inclusion Guidebook 18 3.1 Areas of Support A CYP professional may access the inclusion helpline, operated by KIT, to make a referral or discuss any case or situation related to a child’s participation in a program or supporting a group of children in an inclusive setting. A helpline inclusion specialist can help provide customized suggestions, resources, tips and tools on the following: • Accommodations including physical, material, and environmental adaptations. • Behavior support techniques and suggestions for creating behavior plans. • Communication strategies and supporting communication for children with and without disabilities. • Developmental expectations and designing activities to support a child’s development. • Disability specific information. • E-Learning technical support for self-paced modules and webinars on inclusion-related topics • Guidance on working with families. • Ideas for staff training and follow-up activities for online training. • Strategies for supporting sensory needs. • Suggestions for encouraging peer interactions and facilitating friendships. This list is not designed to be exhaustive and a CYP professional may access the helpline with a specific or general question about any topic related to inclusion. 3.2 Sample Calls and Recommendations Two sample calls and recommendations are described in Exhibit 1 to provide CYP professionals with an overview of a typical helpline call and recommendations.
  24. 24. Navy CYP Inclusion Guidebook 19 EXHIBIT 1: SAMPLE HELPLINE CALLS Summary Recommendations • CYP professionals concerned about a child’s social- emotional development and coping skills. • Behaviors described included crying frequently and using aggression with peers. • Child seems to become frustrated easily and have a difficult time managing frustration. • Strategies for preparing the child for activities ahead of time. • Recommendations for teaching the child to identify when he is feeling out of control. • Suggestions for creating a quiet area. • Examples of calming toys and items to try. • Guidance on providing choice and control. • CYP professional reports child seems angry and is difficult to soothe when upset. • Child does not play with toys in a way similar to his peers. • Child has been observed hitting other children and teachers, spitting, and throwing chairs. • Suggestions for developing a plan to teach play skills. • Recommendations on responding to hurtful language. • Ideas for appropriate responses to aggressive behavior. 3.3 Follow-up CYP professionals should develop a written plan for follow-up on a helpline call. An inclusion specialist will provide several recommendations via email. It is the responsibility of the professional who receives the email (typically the Director or Training & Curriculum Specialist) to share the information with the CYP professionals working directly with the child. It may not be possible or reasonable to implement all the recommendations at once. It is also difficult to identify which supports or accommodations work when there are several strategies being implemented simultaneously. Follow-up plans will also help CYP professionals remain consistent in supporting the child. The process for follow-up should include identifying which strategies or supports the CYP professionals will try first, how the child’s behavior and response to strategies will be documented, and a plan for following up on progress and whether new strategies should be implemented. In some cases, the recommendations will be brought to an IAT meeting, where CYP professionals can work with IAT members to develop a follow-up plan. See Exhibit 2 for a sample follow-up plan.
  25. 25. Navy CYP Inclusion Guidebook 20 EXHIBIT 2: SAMPLE FOLLOW-UP PLAN Child’s Name Date of helpline call: May 25 Recommendations: • Strategies for preparing the child for activities ahead of time. • Recommendations for teaching the child to identify when he is feeling out of control. • Suggestions for creating a quiet area. • Examples of calming toys and items to try. • Guidance on providing choice and control. Strategies being implemented: • CYP professionals will talk to the child about possible solutions to a conflict prior to free play activities and help him identify which strategy to use that day. Visuals will be used when available. Documentation of child’s behavior: • The Lead teacher will observe the child during free play periodically for two weeks (i.e. 3 times per week) and document the child’s behavior and response to teacher-guided selection of possible solutions. Plan for follow-up: • CYP professionals will meet in three weeks to discuss observations and identify new strategies. CYP professionals will decide whether a follow-up call with the inclusion helpline is necessary at that time. An inclusion specialist will also call to check in with the CYP professionals approximately 3 weeks to 1 month after the initial call. This purpose of this call is to see if CYP professionals have questions, and to follow-up on progress and whether the child’s needs have changed.
  26. 26. Navy CYP Inclusion Guidebook 21 IV. Accommodations In collaboration with the child’s family, the Navy CYP Inclusion Helpline, and the IAT, Navy CYP professionals will make accommodations to policies, practices, and procedures in order to support the participation of children with and without disabilities in CYP. This chapter will define the term accommodation, share information about different types of accommodations and provide examples of accommodations in child, youth, and teen programs. 1. Definition A respectful accommodation is an individualized support that promotes access to learning, recreation, leisure or work. It is a change or modification made to expectations, requirements, materials, activities, or the environment. The purpose of an accommodation is to physically, socially, or emotionally support a child’s participation in a program. Designing accommodations involves finding out specifically what each child will need or not need in order to succeed. This is accomplished with case-by-case assessments in collaboration with the family and IAT to determine the child’s needs and available supports and resources. 2. Types of Accommodations Although accommodations are individualized supports and will vary by child, there are four types of accommodations that are helpful to consider when developing supports. • Interpersonal accommodations may support effective communication or support a child during interactions with others. Examples include speaking slowly and clearly for a child who has difficulty processing verbal language, modifying expectations for a child who has a hard time sitting for quiet activities, and modeling turn-taking for a child learning how to play cooperatively with others. • Material accommodations may support a child’s participation in play, motor, and academic activities or interaction with games and program items. Examples include adding Velcro™ to blocks for a child who has trouble stacking, making a card holder for a child who needs assistance holding playing cards, and adding picture instructions to a board game for a child learning to read. • Environmental accommodations may support a child’s sensory or social-emotional needs or navigation within the physical space of the program. Some examples are providing increased opportunities for sensory play for a child who is soothed by tactile play and placing colored tape around the edges of the furniture for a child with low vision.
  27. 27. Navy CYP Inclusion Guidebook 22 • Behavioral accommodations may support a child in learning age-appropriate behavior or in adjusting to the routine and schedule of the program. Behavioral supports include creating a personalized schedule for a child who has trouble transitioning from one activity to another, breaking down rules and expectations and providing concrete examples, and teaching a child coping strategies such as counting to three. 3. Examples of Accommodations In including children and youth with disabilities and other special needs, there are several areas Navy CYP will have to consider in determining what kinds of accommodations and supports are needed: policies, practices, procedures, staffing and the program’s environment, routine, and activities and materials. The examples presented do not represent all possible accommodations for the area described. For more examples or case-specific information, contact the Inclusion Helpline. 3.1 Policies In general, Navy CYP policies support the participation of children with disabilities and other needs. Program-specific policies may need to be adapted on a case-by-case basis to ensure maximum participation from children and youth of all abilities. Examples of accommodations to policies are listed below: • Modifying the orientation process to include a site visit for parents during program hours or allowing the parents to spend time in the classroom with the child so they can get a sense for the program, anticipate where their child may need support, and help the professionals get to know the child. • Adapting a pool safety policy to make an accommodation for a child with low muscle tone who needs to use a flotation device in order to swim. • Developing a policy on assisting with toileting in a school age care program and adapting it as necessary as the needs of the children in the program change. • Reviewing policies on medication administration to make sure they allow for a child to receive adequate care. 3.2 Practices Many times accommodations involve modifications to general CYP professional practices. Practices are based upon what is developmentally appropriate for the age of the children participating and the structure of the program. Some examples of accommodations to practices include the following:
  28. 28. Navy CYP Inclusion Guidebook 23 • Breaking the classroom’s circle-time activities into smaller chunks of time for children who have difficulty staying with the group (i.e. 2 minute book, 2 minute song, 2 minute movement activity) or facilitating smaller group circle-time activities instead of facilitating large group activities with 24 children. • Allowing children to sit, stand, lay down, or to work individually or in groups during homework hour to support different learning styles. • Modifying a community service learning project by presenting one step at a time for a teen with an intellectual disability. • Providing structured activities in a teen club for teens that have a difficult time engaging with peers in unstructured environments. 3.3 Procedures Procedures identify specific actions or series of actions designed to carry out policies. Accommodations to procedures may involve making changes to steps or the sequence of steps. Some examples include: • Adding a step to the procedure for scheduling field trips in which CYP professionals research the accessibility of the location and secure accessible transportation if necessary. • Modifying the serving procedure during snack to limit the children’s access to extra food for a child with a metabolic condition that causes a food compulsion. • Adapting the timeline for a child who may need additional support to transition from one classroom to another (toddler room to preschool room) by beginning the transition earlier and allowing for a more gradual transition. 3.4 Staffing The ratio of adults to children plays a large role in supporting the needs of the children in a program. Many children need additional adult support when they first enter a program until they get used to the routine and schedule. Some children need additional adult support as they transition to a new program (from a CDC to a SAC) and others need additional adult support during certain times of the day. A limited number of children may require ongoing one-on-one support. In order to meet the needs of the children in their care, programs may consider the following: • Shifting staffing schedules to provide additional support to a group of children during a challenging part of the day (an active group of 7 year olds need additional support during quieter activity times, i.e. art project). • Partnering with another CYP within the installation to provide support (a CDC may partner with a Youth and Teen program to get teen volunteers for part of the day).
  29. 29. Navy CYP Inclusion Guidebook 24 • With approval from the IAT, programs are authorized to utilize additional staff to help a child adjust for a period of time, not to exceed 30 days. In the majority of cases, additional staff will only be needed short-term as the child adjusts to the program. In the rare case that additional staffing for a period of time longer than 30 days is recommended by IAT, a funding request may be submitted to CNIC (N91). All requests for long-term additional staff will be re-evaluated after 90 days. After 90 days, programs must re-submit documented justification for continued additional staffing to CNIC (N91). 3.5 Environment The main aspects to consider within the environment are adjustments or accommodations to the physical, sensory, and social-emotional environments. Examples for each are described below: Physical • Creating a quiet area within the program where children can take a break from environmental stimulation – this area should not contain a lot of visual stimulation and be far away from active areas. • Placing program materials on lower shelves and making sure there is adequate space between areas so a child using a wheelchair can easily access materials and navigate the space. Sensory • Providing non-latex gloves for a child who does not like touching art materials or a damp cloth near tactile activities so children can easily remove materials from their hands. • Allowing a child to hold a heavy object on his lap during homework to help him focus. Social-Emotional • Writing a story about a CYP professional getting transferred to another installation to prepare the children for a major staffing change. • Incorporating yoga poses and stretches into the program day to help a child manage stress and anxiety. 3.6 Routine Children and adults benefit from having a consistent routine and schedule and being prepared for program activities. Many children need support in learning the routine and managing behavior when the routine changes unexpectedly. Ideas for accommodations to the routine include the following:
  30. 30. Navy CYP Inclusion Guidebook 25 • Using “First, then” statements to prepare a child for activities throughout the day (“First wash hands, then snack”). • Helping a child get used to the routine and schedule using an object sequence: book for story time, can of play dough for sensory play, soap for washing hands, and toy apple for snack. • Pairing transitions with a calming noise or sound (i.e. soft chime) to signal a change to a new activity. • Providing an optional early snack for a child with low blood sugar. 3.7 Activities and Materials Many children need activities presented in a different way or adapted for their abilities. Children with physical disabilities or low muscle tone may require adaptations to materials to support their independence. Examples of activity and material accommodations are listed below: • Using Velcro™ to attach larger buttons or knobs to existing buttons a video game controller for a teen who has difficulty using fine motor skills. • Pairing pictures with verbal directions to help explain the rules of a game. • Spending time preparing a child for an activity ahead of time (teaching the child how to play Go Fish 1:1 before playing Go Fish with a group of children). • Using wax string to create raised-line coloring pages for a child who is blind. 4. Principles of Accommodations CYP professionals have available resources to assist in designing supports and accommodations. Ideas for accommodations may come from the family, CYP professionals, a KIT inclusion specialist, or IAT members. Trial and error and personal experience and creativity are also key sources of ideas for accommodations. Successfully including all children involves advance planning and each child must be considered in curriculum and program planning. For example, if a program is including a child who is sensitive to noise and the CYP professionals have planned a drum circle for music and movement, they need to have a plan for making an accommodation for this child during music. Perhaps the child may be offered ear plugs or an alternate activity is planned for a small group of children to use scarves in a separate area and move to the music while the larger group is drumming. Accommodations may need to be adjusted or faded over time as the child’s needs change. Many times an accommodation created for a child will work initially and then seem to lose its effectiveness. Making accommodations requires solution-orientated individuals who can recognize when an adjustment is necessary or when the child’s needs have changed. It is important to acknowledge that inclusion is a process and that CYP professionals learn just as much from what does not work for a child as they do from what does work.
  31. 31. Navy CYP Inclusion Guidebook 26 5. Accommodations Versus Exceptions An accommodation is an individualized support that helps a child to participate whereas an exception is excusing a child from participation or changing rules or behavioral expectations for the child’s participation. An example of an accommodation is to provide extra time for a child to complete an art activity. Using the same example, an exception would be allowing the child to do art activities throughout the program day instead of providing support for the child to transition to the other activities offered at the program. At times, CYP professionals may feel as though they are making exceptions instead of accommodations. It is helpful to remember an accommodation as a support for children so that they can follow the same rules and behavioral expectations put in place for all children, rather than as an excuse or exception. CYP professionals may also be concerned that making an accommodation for a child will seem unfair to the other children in the group. There are several ways to address this concern. Finding a way for all children to be involved in the accommodation will work in some instances. For example, if a child needs to hold a small object in her hands to help keep her focused during an activity, perhaps it is acceptable to allow all the children to hold something in their hands. It may help the child who needs it and other children may enjoy being part of the solution. Clear and simple explanations to the group can usually appease inquisitive children. An explanation for why one child is allowed to do something differently might be that it helps him learn more easily, enjoy the activity, or participate more easily. Fairness means that everyone gets what they need, not everyone gets the same. When CYP professionals consistently address the needs (physical, sensory, social and emotional) of all children, the children will come to understand that when they need an accommodation (they are not feeling well, hot, tired, or sad), it will be made for them. CYP professionals that treat all children with respect and model appreciation for differences create environments where children respect and appreciate differences. When a child does voice a concern about fairness, CYP professionals can address the concern calmly, confidently, and kindly and move on to the next topic or activity. When a parent voices a concern about a child or an accommodation, CYP professionals can address the concern with a simple explanation: “We routinely make accommodations for children in our program to support their participation. We keep all information about individual children’s needs confidential. I would be happy to discuss general information about accommodations; however, I cannot discuss a specific child’s supports or accommodations.”
  32. 32. Navy CYP Inclusion Guidebook 27 6. Resources • All Children Together’s website offers resources and information on adaptation and accommodations for young children, including printable samples, at www.ccdh.org/act/young_children. • Find information on supports, modifications, and accommodations for students on the National Dissemination Center for Children with Disabilities website www.nichcy.org. • The Circle of Inclusion website is designed for early childhood providers and parents of young children, www.circleofinclusion.org, and offers information on accommodations, accessibility and awareness.
  33. 33. Navy CYP Inclusion Guidebook 28 V. Disabilities and Special Needs Children with disabilities and other special needs can be found in every community worldwide. They are children of all ages, colors, socio-economic backgrounds and come from various types of families. Children with disabilities have all kinds of interests, abilities, and unique strengths and challenges. Having a disability is only one characteristic among many that make up the whole child. This chapter provides definitions for disability terms and information on the different types of disabilities. However, it is important to realize that each child with a disability or special needs is a child first and more similar to children without disabilities than different. 1. Categories of Disability Most disabilities fall into one of seven general categories: physical, sensory, speech and language, developmental, chronic health, social-emotional, and learning and attention. Each category of disability is described below with areas to consider for supporting children with different types of disabilities. It is important to keep in mind that the information is general in nature. Each child with a disability is a unique individual with his or her own strengths and different areas where he or she may need support. The tips for CYP professionals are also general in nature and will need to be individualized for each child needing additional support in a CYP. 1.1 Physical Physical disabilities include orthopedic impairments and conditions such as spina bifida, juvenile rheumatoid arthritis, scoliosis, osteogenesis imperfecta, amputations, and hip dysplasia. Some children with physical disabilities have limited mobility and use adaptive equipment such as a walker or a wheelchair. Other children with physical disabilities do not use adaptive equipment and may experience limited mobility or difficulty with one area of the body (i.e. limited range in the left arm). See Exhibit 3 for tips for working with children with physical disabilities.
  34. 34. Navy CYP Inclusion Guidebook 29 EXHIBIT 3: PHYSICAL DISABILITIES Areas for support Tips for CYP professionals Safely navigating the physical environment. Become familiar with handling and positioning techniques so that the child is moved safely. The child’s family or therapists working with the child may be able to demonstrate proper techniques. Positioning himself or herself close to other children (i.e. on the floor, at the sensory table). Give all CYP professionals working with the child opportunities to hold and position the child so that everyone is comfortable providing physical assistance. Always ask the child before you touch their equipment or move them. Remember to tell the child where you are taking him. Using and caring for specialized equipment. Respect the personal space of children who use specialized equipment. Do not hang or lean on a child’s wheelchair. Completing activities such as dressing, toileting, interacting with sports equipment, or doing art projects. Provide a piece of adaptive equipment such as a card holder, a wheelchair lap tray or universal utensil holder for a crayon, fork or spoon. Encouragement to complete activities independently where appropriate. Know the child’s strengths and areas where independence can be encouraged and supported. Adapting the environment (i.e. lowering the sensory table so a child using a wheelchair can easily access it). Modify the environment and materials to maximize participation for all children. 1.2 Sensory Sensory impairments include children who are deaf and/or hard of hearing, blind or have a visual impairment. It is important to know what a child is able to hear or see if she has a sensory impairment. Many people assume that children who are blind cannot see anything when many children are able to see outlines, shadows, or certain colors and contrast of light. Similarly, many children who are deaf are able to hear certain pitches or tones. See Exhibit 4 for tips for working with children with hearing and vision disabilities.
  35. 35. Navy CYP Inclusion Guidebook 30 EXHIBIT 4: HEARING DISABILITIES Areas for support Tips for CYP professionals Communicating with other children and CYP professionals. Know the degree of hearing loss and how the child communicates (i.e. sign language, lip reading). Speak in full sentences at a normal speed. Provide visual cues such as pictures and symbols. Following verbal directions. Make sure to get the child’s attention before giving instructions. Demonstrate tasks and activities in addition to providing verbal directions. Following conversations and activities. Give the child a signal to use if he does not understand something. Active participation in games and activities. Provide opportunities for the child to communicate. VISION DISABILITIES Areas for support Tips for CYP professionals Safely navigating the physical environment. Be aware of sharp edges on tables, curled up edges on rugs, and other physical obstacles in the program. Pay attention to decreasing and increasing room light to avoid glares. Following verbal directions. Use specific language when giving directions. Avoid using words such as this, that, or over there. Following conversations and activities. Address children and CYP professionals by their names so the child knows who is speaking to whom. Active participation in games and activities. Incorporate hands-on experiences to learning and other activities such as touching, tasting, smelling, and manipulating. Purchase or borrow audible sports equipment. Encouragement to complete activities independently where appropriate. Ask the child if she needs assistance before assuming she needs help. Adapting materials. Use print materials that are clear and easy to see. 1.3 Speech and Language Speech and language disorders are conditions involving difficulty with the voice or producing speech sounds, trouble understanding others (receptive language), or sharing thoughts ideas, and feelings (using expressive language). Examples include apraxia, articulation disorder,
  36. 36. Navy CYP Inclusion Guidebook 31 dysfluency, stuttering, speech impairments, and delays in the acquisition of language. .See Exhibit 5 for tips for working with children with speech and language disorders. EXHIBIT 5: SPEECH AND LANGUAGE DISORDERS Areas for support Tips for CYP professionals Completing sounds, syllables, and words. Provide opportunities for the child to practice coordinating speech (i.e. play a game making sounds in front of the mirror). Articulating sounds and combining consonant sounds (i.e. “th” or “gr”). Model the correct usage and pronunciation of words rather than correcting the child. Speaking fluently . Be a patient listener. Give the child the time she needs to say what she wants to say. Understanding questions and following directions. Keep directions simple and present them in complete sentences. Encourage the child to repeat directions. Learning words to rhymes or songs. Provide frequent and concrete visual reinforcement during new activities (i.e. use a felt board and characters for new songs) Expressing ideas clearly. Expand on what the child says and ask specific questions. 1.4 Developmental Developmental disabilities are defined as severe, chronic disabilities that occur any time between birth and 21 years of age that are expected to last a lifetime. Developmental disabilities are not always visible and may be cognitive, physical or a combination of both. Developmental disabilities include autism spectrum disorders, Fragile X syndrome, Downs syndrome, cerebral palsy, and intellectual disabilities. .See Exhibit 6 for tips for working with children with developmental disabilities.
  37. 37. Navy CYP Inclusion Guidebook 32 EXHIBIT 6: DEVELOPMENTAL DISABILITIES Areas for support Tips for CYP professionals Remembering and following directions. Present directions one at a time with visual cues (i.e. pictures or objects). Speak slowly and clearly and provide written directions where appropriate. Applying skills to new situations or new people. Prepare a child for a new situation by talking about it beforehand, sharing pictures and other relevant information. Making decisions. Limit choices to two or three options and help the child decide what to do first, second, and third during free choice activities. Developing communication and social skills. Plan cooperative activities to create opportunities for the child to interact with peers. Using self-help skills (i.e. eating snack, washing hands). Break tasks down into small, manageable steps. Solving problems. Help the child think through possible solutions to a problem. Transitioning from one activity to another. Give extra cues about impending timelines and help prepare the child for the next activity. Keep activities structured with a clear beginning, middle, and end. 1.5 Chronic Health Conditions Chronic health conditions are defined as conditions which last at least 12 months and are severe enough to result in limitations to daily activities. Examples include allergies, asthma, cystic fibrosis, diabetes, and hemophilia. The Council for Children and Adolescents with Chronic Health Conditions outlines four contributing factors: • Biologically-based. • Lasts for an extended period of time. • Brings about significant change in the child’s life. • Requires more than the usual amount of medical care. Chronic health conditions can be treated but not cured. Children with chronic health conditions visit the doctor more frequently than other children and their wellness may fluctuate. Clear communication with the family and written health and emergency plans are critical to providing support for a child with a chronic health condition:
  38. 38. Navy CYP Inclusion Guidebook 33 • Talk to the family. Some families may worry about sharing information about their child’s condition. Explain how the CYP keeps information confidential. Ask for permission to contact the child’s pediatrician (written permission from the family is also needed for the pediatrician to discuss the child with CYP). • Make an emergency plan. A parent may suggest that CYP professionals contact the child’s pediatrician for detailed information about the child’s condition. In this case, it is recommended that programs obtain written permission from the family to contact the child’s pediatrician. Make sure CYP professionals know how to reach the family and pediatrician in case there is an emergency. • Make a health plan. If the child takes medicine during program hours, inform the parents of policies for storage and self-usage. Make sure the child is able to take her medicine in a comfortable place. • Plan ahead. Meet with the child’s family regularly to talk about how the child is doing in CYP. Share observations about any changes in behavior (especially when the child is changing medications or dosage). 1.6 Social-Emotional Disorders Social-emotional disorders affect a child’s mood, energy, thinking, learning and behavior. Social-emotional disorders include attachment disorders, emotional disturbance, bipolar disorder, depression, anxiety disorders, and oppositional defiant disorder. Children with social-emotional disorders often have a difficult time controlling their moods, reactions, impulses, anxiety, and interactions with others. See Exhibit 7 for tips for working with children with social-emotional disorders.
  39. 39. Navy CYP Inclusion Guidebook 34 EXHIBIT 7: SOCIAL-EMOTIONAL DISORDERS Areas for support Tips for CYP professionals Controlling mood cycles. Teach children relaxation techniques such as breathing and visualization exercises. Remind the child of the exercises when he seems to have a difficult time controlling his mood. Stopping or limiting anxious thoughts. Help the child learn to identify and change anxious thoughts (i.e. use positive self talk “I can do this.”) Inhibiting impulsive behaviors. Teach the child to identify when she is feeling out of control. Point out her body signals (i.e. hands in fists) and have her practice taking a deep breath or stretching to help alleviate impulses. Meeting behavioral and environmental expectations. Provide routines and structure for the child. Predictability may assist him in developing strategies to meet expectations. Remain consistent with expectations and support the child in learning strategies to meet them. Coping with sudden changes or unexpected events. Do not change activities or the schedule abruptly. Allow adequate time for the child to adjust to change by preparing her ahead of time. Regulating emotions. Allow the child to take a break from a stressful activity or situation in a quiet area. Support the child with proximity – offer reassurance and encouragement as needed. Participating in group games and activities. Provide time for the child to practice new activities before they occur or allow children to watch new activities before they participate. 1.7 Learning and Attention Learning and attention disabilities are neurological disorders that vary from child to child and include attention deficit hyperactivity disorder (ADHD), dyslexia, dysgraphia, nonverbal learning disabilities, and sensory processing disorders. Children with learning disabilities have differences in the way their brains process information (i.e. language, motor and executive function). Children with attention disabilities have a difference in the level of neurotransmitters in the brain resulting in age-inappropriate symptoms of hyperactivity, distractibility, and impulsivity. See Exhibit 8 for tips for working with children with learning and attention disabilities.
  40. 40. Navy CYP Inclusion Guidebook 35 EXHIBIT 8: LEARNING AND ATTENTION DISABILITIES Areas for support Tips for CYP professionals Participating in academic activities (i.e. circle time or homework hour). Use multi-sensory activities that include auditory, visual, and tactile components (i.e. play a song and use pictures). Assist a child with staying on task during homework (i.e. make a list and check off tasks as they are completed). Managing impulsive behaviors. Be tolerant of interruptions during group games and activities. Use visual cues to signal when it is time to share out loud (i.e. use a “talking stick”). Ignore negative behavior when possible. Transitioning from one activity to another. Use personalized cues to signal a transition (i.e. hand signal, silly song). Remind the child of behavioral expectations for the next activity. Allow the child to bring a comfort item from one area to another. Keeping track of personal belongings. Help the child organize personal belongings and keep them in a consistent place. Provide a list of materials for activities. Regulating responses to the sensory environment. Observe how the child reacts to different types of sensory stimulation (i.e. light, sound, touch, movement). Offer the preferred stimulation when the child seems overwhelmed. Releasing energy in appropriate ways. Establish an area indoors where it is okay for a child to get up and move (i.e. place a hula hoop on the ground where children can jump). Maintaining attention and interest. Incorporate the child’s special interest into a game or activity. Provide something to do while children are waiting for a turn. Reduce the amount of time for an activity when needed. 2. Children with Special Needs Children with special needs are children who require more than routine and basic care including children with or at risk of disabilities, chronic illnesses and physical, developmental, behavioral, or emotional conditions that require health and related services of a type or amount beyond that required by children generally (Federal Maternal and Child Health Bureau). Approximately 14% of children have special needs and 1 in 5 households with children in the United States have at least one child with special needs. The 2005-2006 National Survey of Children with Special Healthcare Needs identified the following functional difficulties as the most common difficulties for children with special needs:
  41. 41. Navy CYP Inclusion Guidebook 36 • Respiratory problems. • Learning, understanding or paying attention. • Feeling anxious or depressed. • Managing behavior and meeting behavior expectations. • Speaking, communicating or being understood. • Making and keeping friends. Children with special needs are protected by the RA 1973 Act and Navy CYP is required to make reasonable modifications to support their participation in CYP. 3. Additional Resources • Attention Deficit Disorders Association, www.adda-sr.org. • Center for the Social and Emotional Foundations for Early Learning, www.vanderbilt.edu/csefel. • Disability Statistics and Information, www.disabilitystatistics.org. • Learning Disabilities Online, www.ldonline.org. • National Dissemination Center for Children with Disabilities, www.nichcy.org. • Special Needs Project, www.specialneeds.com. • The Child Anxiety Network, www.childanxiety.net.
  42. 42. Navy CYP Inclusion Guidebook 37 VI. Behavior Support Sometimes the most challenging children to include are not the children with the most severe disabilities. It can be much more straightforward to make accommodations for a child who is blind, or a child who uses a wheelchair. Sometimes, the greatest challenge to child and youth professionals is the child with disruptive behaviors. Accommodations can be harder to find, and may need to be changed over time. It can also be harder to guide a child with challenging behaviors in developing friendships with other children in the group. This chapter will address how to understand and interpret behavior, the positive behavior support process, how to develop and implement behavior plans, and techniques and procedures to support more positive behavior for all children. 1. Understanding Behavior All behavior is communication. Children’s actions often communicate the way they feel and what they want. There are two main ways to describe behavior: by its type and by its purpose. Behavior is something you can see, hear, and measure. Observable actions such as crying, screaming, hitting, and spitting are all types of behavior. The purpose of the behavior is why the child is acting in a certain way. Sometimes, the purpose of the behavior is to get something the child wants, other times it is an attempt to avoid a situation or activity. The important thing to remember is that all types of behavior communicate the child’s needs. The need may be “I need a drink”, or the need may be “I don’t want to participate”. When we begin to design behavior support and intervention strategies, we must consider both the type of behavior and its purpose. There are several factors to consider with behavior, so one approach or a “cookie cutter” approach to dealing with behaviors will not work. Behavior is influenced by a variety of factors including the child’s temperament, what is happening at home, and sensory and environmental stimuli, all of which in combination can present a clear picture of both the purpose of the behavior and how to respond. There are many events that influence behavior for any given child. These events fall broadly into six categories: • Temperament. • Deployment. • Activities. • People. • General environmental features. • Physiological states.
  43. 43. Navy CYP Inclusion Guidebook 38 1.1 Temperament A child’s temperament can be described as his or her general outlook on life. It is an emotional reaction or way of responding that is also sometimes referred to as a “disposition.” All children have a temperament that is natural to them. It defines who they are and how they react in certain situations. It is something that they are born with, and something that can be observed in behavior patterns of childhood. Temperament involves three areas that can be viewed on a continuum of low to high: • Energy level: the child’s average level of activity in daily life. • Adaptability: how the child adjusts to sudden changes or transitions. Some children adapt to the environment easily and for others it takes longer to adapt. • Approach: how the child approaches new situations and people. It can range from eager to more hesitant to slow-to-warm up. Thomas, Chess and Birch (1968) first described characteristics of temperament and suggested that most children will be clumped into three basic types of temperaments. These three types are described in Exhibit 9. EXHIBIT 9: TYPES OF TEMPERAMENT Type Behaviors Tips “Easy” or flexible. Adaptable, approachable and positive in mood. Be cautious of asking the child to be the “helper” all of the time. “Difficult” or active. Adapts slowly to change, is often negative in mood and may exhibit intense reactions to environmental demands. Remain responsive, flexible, patient and understanding and balance active activities with quiet activities. “Slow to warm up” or cautious. Tends to withdraw from or exhibit negative responses to new situations. Provide extra time for the child to adapt to novel situations and prepare her for changes in routine. CYP professionals can and should reflect on their own temperaments and coping styles and while it would be ideal to match caregiver temperaments with children’s temperaments, that is not always realistic. .It is the responsibility of the adult to support and influence the child’s interactions so that difficult temperamental traits can be modified by giving the child the skills and confidence to manage environmental demands. .Avoid insulating children from all stressful situations. It is important to know how and when it is appropriate to make certain demands on a
  44. 44. Navy CYP Inclusion Guidebook 39 child, knowing that the child can meet them successfully. .The ability to present just right challenges will help develop coping skills and successful mastery. 1.2 Deployment The three phases of deployment: pre-deployment, deployment, and reunion create unique issues for children and youth (Military Child Education Coalition). The stress of deployment manifests differently according to the age of the child. The distress experienced by infants is influenced largely by the remaining caregiver’s sadness and anxiety. Behavior changes in infants may include irritability, unresponsiveness, difficulty sleeping and eating, and excessive crying. Toddlers, who are at a period in their development where they normally experience separation anxiety, may cling more to the remaining parent and resist their daily routine. Preschoolers with a deployed parent may start to regress to behaviors that they have previously outgrown (i.e. may have frequent accidents when they were previously able to use the bathroom independently). In a CDC or CDH, preschool-aged children may become more aggressive and demanding or cry often while they are experiencing the phases of deployment (Lincoln, Swift, & Shorteno-Fraser, 2008). School-age children and teenagers may worry about the threats associated with war and their loved one’s safety. Behavioral changes that CYP professionals may notice are excessive worry, difficulty paying attention, defiance, aloofness, and a loss of interest in activities. Children and youth with anxiety and depression may be more vulnerable to poor adjustment during a parent’s deployment. It is important for CYP professionals to document and monitor any changes in behavior and pay close attention to the behavior of children and youth who have social- emotional disorders. Close communication about any behavioral changes with the remaining parent is crucial to supporting the child and family during the phases of deployment. 1.3 Activities A child’s day is comprised of a number of different activities and routines. Some activities may be unpleasant and influence challenging behavior. An activity may be unpleasant if it is difficult for the child to complete. Activities become problematic if they are not matched to the child’s skill level or exceed a child’s endurance level. For example, a child may avoid art activities due to difficulty using fine motor skills. Another child may avoid sports because he has low muscle tone and tires easily. Activities can also influence challenging behavior if the child does not like doing them. A child may be capable of using the bathroom independently but does not enjoy the task.
  45. 45. Navy CYP Inclusion Guidebook 40 1.4 People People, and more specifically the presence or actions of another person, also influence behavior. Unpleasant interactions such as directions issued in a harsh tone, can influence negative behavior. Using choice (“Would you like to color or read?”) and conditional choice (“When you are ready, please come join us”) are more effective than using direct imperatives (“You need to color your picture now”) or indirect imperatives (“Do you want to color?”). Children are also influenced by a lack of interaction. A child may use a negative behavior as a way to receive attention from other people in the environment. 1.5 Environment Although behavior always has a purpose, the purpose of a child’s behavior is not always clear to parents, CYP professionals or other professionals working with the child. General environmental features often play a role in influencing behaviors that do not seem to have a clear purpose. The environment in a CDC, CDH, or CYP includes the physical location of the facility or home, the sensory stimuli in the space, the materials available, and the children and adults participating in the program. The children in CYP have their home environment, their school environment, and the CYP’s environment. For a child, all these environments have different demands, and the adaptation that it takes to move from one environment to the next may be very difficult. Children in the Navy’s CYP may also experience a lot of instability in where their family is stationed and may have to adjust to several home environments and neighborhoods. Each environment has different rules, different people who inhabit it, different noises, smells and a different level of visual stimulation. CYP professionals should routinely evaluate the following elements of the program and modify as necessary. The environment has a tremendous impact on all the children in CYP, and can have an especially big impact on children with disabilities. Physical Environment • Physical structure of space including size of rooms, size of outdoor space, physical placement of fixed furniture, physical placement of moveable objects, toys, equipment, type and placement of playground equipment. • How children and youth are grouped (examples include small groups, large groups, in circles, in lines, seating on the floor, sitting in desks, sitting on carpet squares, sitting on chairs). • Spatial arrangement of activity centers and adequate space between centers as well as clearly defined pathways. • Organization of and accessibility to materials. • Amount of materials and duplication of materials/equipment/toys.
  46. 46. Navy CYP Inclusion Guidebook 41 • Ratio of adults to children, particularly in areas where more support and supervision is needed (for example, in the block area of a classroom including several active children who tend to knock over blocks frequently). Sensory Environment • Amount and type of visual stimulations or visual distractions. • Level of noise in the environment (including background or “white” noise). • Amount and type of tactile activities in the environment (textures such as finger paint or foods, or certain types of touch such as brushing up against someone or giving a high five). • Opportunities to experience a variety of movement activities from playground equipment, physical play, games and recreation, music and dance. Social-emotional Environment • Consistent, predictable caregivers and staff who promote social emotional growth. • Use of routines and rituals, particularly for children who experience stress or anxiety during transitions. • Minimal changes in the schedule and preparation for children when there are changes in the schedule, environment or staff. • Attention to transitions and use of appropriate cues and signals when a transition is going to occur. • Adults who are physically and emotionally available to children and not caught up in conversations with other adults. • Adults who are clearly telling children what behaviors are expected and attentive and responsive to children. 1.6 Physiological States A child’s physiological state also has an influence on their behavior. If the child is not feeling well, has low blood sugar, eczema, or other health-related concerns, he may be communicating how he feels using behaviors like yelling or aggression. Children who have a difficult time communicating with words will often use behavior to tell adults that they are in pain or feeling out of sorts. Teen girls may have differences in behavior during periods of menses. When a child’s behavior changes or is difficult to interpret, encourage the family to take the child to the doctor in order to consider medical or physiological influences on behavior.

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