Improving Inclusion for Children With Special Health Care Needs in Childcare Settings: Results From a Statewide Survey of Childcare Professionals

Published:December 16, 2022DOI:
      ABSTRACT Introduction: Families of children with special health care needs (CSHCN) routinely struggle to find suitable childcare. These families value childcare capable of supporting their child's needs, known as inclusive care, that requires trustworthy staff trained to safely care for CSHCN. Method: This study aimed to understand the training, experience, confidence, and perceived barriers to providing inclusive care for CSHCN from the perspective of childcare providers and directors. Childcare providers (n = 263) and directors (n = 418) responded to a statewide survey in Wisconsin in 2019. Results: Results show that both childcare providers and directors perceive that the providers lack confidence in providing inclusive care. Lack of staffing, training, and expertise of childcare providers were the most frequently reported barriers to provide inclusive care. Discussion: These findings confirm the need for additional education, training, resources, and research to create and maintain more inclusive childcare settings for CSHCN.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Health Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson L.S.
        The development and implementation of eSchoolCare: A novel health care support system for school nurses.
        ANS. Advances in Nursing Science. 2013; 36: 289-303
      1. Center on Wisconsin Strategy. (2015). The state of working Wisconsin.

      2. Child and Adolescent Health Measurement Initiative. (n.d.b). 2019–2020 National Survey of Children's Health (NSCH) data query.

        • Clapham K.
        • Manning C.
        • Williams K.
        • O'Brien G.
        • Sutherland M.
        Using a logic model to evaluate the Kids Together early education inclusion program for children with disabilities and additional needs.
        Evaluation and Program Planning. 2017; 61: 96-105
        • Derigne L.
        • Porterfield S.L.
        Employment change among married parents of children with special health care needs.
        Journal of Family Issues. 2017; 38: 579-606
      3. Gould, E., Whitebook, M., Mokhiber, Z., & Austin, L. (2020). A values-based early care and education system would benefit children, parents, and teachers in Wisconsin.

        • Ishiguro K.
        • Yoshioka S.
        Realities and challenges of support for children with special needs in nursery schools.
        Yonago Acta Medica. 2016; 59: 25-35
      4. Kuo, D. Z., & Turchi, M. M. (2022). Children and youth with special health care needs.

        • Mulvihill B.A.
        • Cotton J.N.
        • Gyaben S.L.
        Best practices for inclusive child and adolescent out-of-school care: A review of the literature.
        Family and Community Health. 2004; 27: 52-64
        • National Survey of Children With Special Health Care Needs
        Data query from the Child and Adolescent Health Measurement Initiative.
        Data Resource Center for Child and Adolescent Health. 2001;
      5. U.S. Chamber of Commerce Foundation. (2020). Piecing together solutions: The importance of childcare to U.S. families and businesses.

      6. United States Department of Health and Human Services., & United States Department of Education. (2015). Policy statement of inclusion of young children with disabilities in early childhood programs.

        • Van der Lee J.H.
        • Mokkink L.B.
        • Grootenhuis M.A.
        • Heymans H.S.
        • Offringa M.
        Definitions and measurement of chronic health conditions in childhood: A systematic review.
        Journal of the American Medical Association. 2007; 297: 2741-2751
        • Weglarz-Ward J.M.
        • Santos R.M.
        Parent and professional perceptions of inclusion in childcare.
        Infants and Young Children. 2018; 31: 128-143
      7. Wisconsin Department of Children and Families. (2016). What's working: Inclusion efforts in WI.

      8. Wisconsin Department of Children and Families. (n.d.a). Child care regulation information for providers.

      9. Wisconsin Department of Children and Families. (n.d.b). What is early childhood inclusion?.∼:text=Inclusion%20is%20the%20practice%20of,same%20daily%20activities%20and%20routines.

      10. Wisconsin Early Childhood Association. (2016a). Childcare matters: 2016 annual report.

      11. Wisconsin Early Childhood Association. (2016b). Wisconsin's child care workforce: Wages, benefits, education and turnover of the professionals working with Wisconsin's youngest children.

      12. Youngstar. (n.d.). Be an inclusive child care provider.