Worker and Family Assistance:
Department of Defense Policies on Accommodating Children with Special Needs in Child Care Programs
GAO-13-165R: Published: Jan 16, 2013. Publicly Released: Jan 16, 2013.
What GAO Found
DOD officials stated that their policy is to accommodate children with special needs unless those accommodations fundamentally alter the nature of the program. However, DOD does not centrally collect or maintain data on accommodation decisions; instead they are kept at the installation level. Two services--Army and Air Force--have begun or plan to collect specific data at the service level to monitor and track services to children with special needs across their installations by 2013. Further, the services have different definitions of special needs, although officials told us DOD is working on a standard definition. According to OSD officials, each service has established an assessment process to determine how to accommodate children with special needs in DOD's child care programs. This assessment process is the primary means through which parents can address concerns related to finding appropriate child care for their children with special needs, as well as to help identify support and outreach programs for the family. The National Defense Authorization Act for Fiscal Year 2010 created the Office of Special Needs, which is responsible for enhancing and improving support for families of children with special needs. Although DOD officials stated that this office does not have an oversight role or enforcement authority over DOD child care, the Office of Special Needs and OSD have coordinated on some activities to better serve the DOD population of children with special needs. Additionally, DOD contracts with Kids Included Together to support the work of its child care staff in accommodating children with special needs and offers other services to help child care staff and parents deal with behavioral problems and other issues. Representatives of national disability organizations said that military parents of children with special needs face challenges accessing DOD child care that go beyond those faced by nonmilitary parents of children with special needs in accessing private child care. For example, in some cases military families never make it to the top of waiting lists for local special needs services due to frequent moves.
DOD monitors child care programs' compliance with accommodation policies through its inspection process as well as evaluations of program performance in national accreditation reviews. Inspections include criteria that address inclusion of children with special needs. For example, they may assess whether equipment, material or furnishings are available to provide access for children with disabilities to the program's curriculum and activities. They may also assess whether there is a process in place to develop strategies to support children with special needs. According to DOD officials, all CDCs in the four services had passed or were in the process of passing their inspections for fiscal years 2011 and 2012. Accreditation reviews by national organizations also include criteria related to access and accommodation of children with special needs, and DOD officials told us that almost all CDCs were accredited or were in the process of becoming accredited in fiscal years 2011 and 2012.
DOD reported that child care programs follow the individual services policies for administering medications. Those policies vary and in some cases are in flux. The Navy and Marine Corps have policies allowing trained DOD child care staff or nurses to administer medications prescribed to manage severe complications of epilepsy and diabetes, while the Army and Air Force are in the process of updating their policies for administering these medications. Our search of legal databases did not find any ongoing cases against the military regarding the denial of child care due to special needs services. Recently, the Army was named as a defendant in a lawsuit involving the refusal to administer a medication to a child with special needs by CDC staff to stop seizures in an emergency. The suit was settled in August 2011.
Why GAO Did This Study
The Department of Defense (DOD) subsidizes child care programs to assist military families, including many with children with special needs, in balancing the competing demands of family life, accomplishing the DOD mission, and improving their financial health. Although DOD has a number of child care programs on and off installations, most military families who use DOD-provided care use Child Development Centers (CDC) or other forms of on-installation care, such as family homes. DOD child care is not guaranteed to all who need it, and the availability of such care depends on demand and the services' budgetary resources. However, when space is available, DOD officials stated that the military services are required to offer accommodations to children with special needs unless those accommodations fundamentally alter the nature of the program. For example, a child with special needs requiring constant one-on-one care may be denied a slot in a CDC, which is a group setting, because that level of care would result in a fundamental change to the nature of the program.
Senate Report 111-201 directed DOD to report on a number of issues related to children with special needs in the areas of education and child care, including services and challenges for military dependent children with special needs and their families. The Senate Report also directed GAO to review DOD's report. We recently issued a report on DOD schools to fulfill part of this requirement, but because child care service delivery structures differ, we examined the child care portion separately. This product describes key DOD policies and procedures for: (1) accommodating children with special needs, (2) monitoring program compliance with accommodation policies, and (3) administering medication to children with special needs to relieve symptoms quickly in emergencies4 and related litigation, if any.