Abstract
Inclusion or full participation by children with disabilities in programs and activities designed for typically developing children benefits children with and without disabilities and their families. Inclusive care programs are least available for school-age children and adolescents. A review of the literature identified best practices for effective inclusive out-of-school care, including: a written program philosophy; a written plan for inclusive programs; strong leadership; a disability awareness program for staff and children; training and support for staff; sufficient staff to meet program needs; a working communication and collaboration; an adapted setting, activities, and time parameters; proficient collaboration with families; and an evaluation plan.
TWO KEY PIECES of legislation guarantee the civil and educational rights of people with disabilities: (1) the Americans with Disabilities Act (ADA) and (2) the Individuals with Disabilities Education Act (IDEA). The ADA, signed into law in 1990, is a comprehensive civil rights law protecting individuals with mental or physical disabilities from discrimination. It prohibits discrimination in employment, state and local government services, public transportation, telecommunications, and public accommodations. Public accommodations include private programs, family child care homes, child care centers, and after-school programs for children and youth. 1 The IDEA ensures educational rights by giving states the responsibility of providing a free, appropriate public education to all children. 2 A key issue embedded in these mandates is that individuals with disabilities should be able to participate equally in all activities with their peers without disabilities. This requirement has raised many challenges for those who provide services to children with disabilities as it established the expectation that services will be provided in inclusionary environments. 3 The enactment of these laws has naturally contributed to the creation and implementation of inclusive care and education of children and adolescents.
Children and youth with disabilities have been defined in a variety of ways. Prevalence estimates of this population range from greater than 5% to less than 30%. 4-8 Newacheck et al 5 discusses the 3 most common approaches to identifying and classifying children with chronic conditions and ongoing health problems as: (1) condition lists, (2) functional impairments, and (3) activity limitations. Used alone, each of these approaches offers a limited understanding of children and youth with disabilities. More recently, the trend has been to shift from a narrow view to a broader conception of the population promoted by the Maternal and Child Health Bureau's Division of Children with Special Health Care Needs. 7 Application of the comprehensive definition of disability, which includes children with or at risk for physical, cognitive, emotional and behavioral conditions who also require services beyond that required by typically developing children of the same age, has more consistently yielded prevalence estimates of between 15% to 20%. 4-6 This broader definition has been applied in this review.
Within educational settings, inclusion has generally been defined as providing education to a child or youth with disabilities within the general education classroom and providing appropriate services, supports, and accommodations as needed. This has typically taken place at the neighborhood school or the school the student would normally attend if he or she did not have a disability. Children and youth with special needs may spend all (full inclusion) or part of their day (partial inclusion) in regular classrooms. 9
The definition of inclusive child care is full participation by children with disabilities in preschool or out-of-school programs and activities designed for typically developing children. As in the school environment, special services, such as speech, language, and physical or occupational therapy, must be provided to children with disabilities served in inclusive child care settings to accomplish established goals. 10 The Twentieth Annual Report to Congress on the Implementation of the Individual with Disabilities Education Act stated that 51.6% of preschool children aged 3-5 with disabilities were served in regular classrooms. 11