Report: Less than 25% of Tarrant County child care centers accept kids with disabilities

As child care spaces struggle to find stability amid a flawed system underscored by high tuition rates for families, minimal profits for providers and low wages for early educators, another challenge comes into play within the sector: providing quality care to children with disabilities.

A report released last week by the Early Learning Alliance, a collaboration of more than 50 organizations focused on bettering children's education and lives, found that fewer than 25% of licensed or registered child care programs in Tarrant County accepted these children in 2023. The report, "Early Care and Education in Tarrant County, Texas: Community Feedback on Child Care Navigation," revealed that families with children who have specialized needs are among groups that are more likely to encounter roadblocks with child care.

Providers say a lack of funding, resources and training for their staff forces them to turn away children they're unable to accommodate. Despite more than 1,000 child care programs countywide, options are limited for parents, causing them to cut back at work or stay at home with their child full-time. This creates a further, negative ripple effect to the local economy.

"Representatives from Tarrant County Child Care Management Services, Child Care Regulation, and Workforce Solutions for Tarrant County were not aware of any child care programs or providers in the county that exclusively serve children with disabilities, or providers with specialized expertise in caring for children with disabilities or differences," according to the report. "Many parents reported that they determined early on in their child's life that an adult in the family would be required to leave the workforce to care for the child."

Natalie Dorsey, a Fort Worth mother to a 5-year-old son who is nonverbal and autistic, said she doesn't see a possibility for her to return to a full-time job for the foreseeable future, as her son Bryan needs constant supervision and is consistently going to therapy and doctor appointments that would overlap with a typical 9-5 work schedule. Bryan currently is in speech therapy and applied behavior analysis therapy, known as ABA, which aims to help people with autism improve social interactions, increase positive behaviors and decrease negative behaviors.

When Bryan was at infant and toddler ages, Dorsey and her husband were unable to find child care within their budget and relied on Bryan's grandparents to care for him when Dorsey worked two days a week to supplement their family's income, she said. Although Bryan was able to attend pre-K in the Fort Worth Independent School District from 3 to 5 years old, Dorsey said he made limited progress versus having private, full-time therapy, which he has been doing for the past nine months.

"In the short amount of time that he's been in ABA (therapy), we're increasing his verbal output, he's learning new things, he's counting more numbers, he's identifying more letters, shapes, colors. He's doing far more than what he was able to learn in two years in regular school because he has that one-on-one attention that he needs," Dorsey said.

The facility where he receives these therapies provides a scholarship to Dorsey's family that covers the remaining cost of what their insurance won't cover, making Bryan's care more accessible, she said.

"All of the politics behind (child care) saying, 'Oh, if you give people these assistances, then they won't want to work.' -- No, the more assistance that our family has gotten means the more hours I can work, the better I can provide for my family," Dorsey said.

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As a parent of a child who needs certain care and accommodations, Dorsey feels as if the child care system in general has worked against families like hers.

"The system is rigged so that you'll fail -- that's what it feels like," she said. "It doesn't feel like we're actually doing this for our children. Because if we were really focused on doing this for our children, they would have a million state-funded facilities that are open 24/7 that would be able to take care of any child, whether they be medically fragile or any perfectly healthy child from all ages."

Child care providers in Tarrant County can access resources for children in their care who have disabilities, but in order to qualify, the child must be utilizing a scholarship from Child Care Management Services, which has a long waiting list, according to the report. Alongside the scholarship, a parent must request the support themself and documentation must be provided of the child's diagnosis.

"Additionally, children who are too young to be formally diagnosed, yet are exhibiting early signs of a disability, are not eligible," the report states.

A combination of identifying these diagnoses early on and creating more efficient communication between families and providers on a child's specialized needs could improve these gaps, according to the report.

Audrey Rowland, founder and CEO of Green Space Learning, said all families who enroll their children at Green Space Nature Preschool, located on East Belknap Street near downtown Fort Worth, visit the program in-person first and then provide information about their child's behaviors and interests. If a parent voices specialized needs for their child, an additional conversation about their accommodations will determine how staff can provide that care, and then a check-in happens after 30 days.

"The purpose of that time is to observe the child but also to give us enough time to make the proper accommodations, so that we can kind of try things and see if that's working," Rowland said, noting factors such as teacher-to-child ratios, scheduling and equipment.

When it comes to providing care to children with specialized needs, Rowland and her staff typically serve children with neurodivergent diagnoses such as autism, she said. The curriculum of Green Space is based on child choice and open-ended play, which gives more freedom and flexibility for the children and allows them to have a personalized routine catered to their needs. In Rowland's experience, this set-up has made it easier to serve children with disabilities.

Although her staff has the training and resources to provide care for these children since Green Space is a professional development company, the sector as a whole is lacking access to such training, in addition to the basics of developmentally appropriate practices and child development.

"Early childhood is a pretty specialized need in and of itself. We're struggling to meet even just that specialized need, and then when it is compounded with additional developmental issues or needs, it's incredibly challenging," Rowland said. "There are some fundamental systemic things that make it difficult for our field to be flexible for those needs."

Report to help find solutions; New pediatric facility opens

The Early Learning Alliance report, conducted from February through June 2023, came about through focus groups and interviews with 120 people who either regulate, advise or utilize the child care system. Its findings will inform the operations of the Tarrant County Child Care Navigation Program, which helps families find child care tailored to their needs while supporting child care providers with developmental screenings, mental health resources and other services dedicated to inclusive learning.

Three child care navigators hired by My Health My Resources of Tarrant County are facilitating the connections between providers, families and existing resources. These navigator roles came out of the "high and increasing volume of referrals including child care needs" from Help Me Grow North Texas' navigation system, which connects families with community-based resources. Between April 2020 and October 2023, more than 8,000 referrals were made from families and more than 16,000 community resources were provided in Tarrant County, according to the report.

"We already have early childhood interventionists that are serving in child care centers, we have mental health consultants that are already coaching providers in classrooms, in child care centers. We're sharing that information with other places, so that they know what resources are already available that they may not be accessing," said Jennifer Cox, child and family services community development director of My Health My Resources of Tarrant County.

Bethany Edwards, director of the Early Learning Alliance and co-author of the report, said the findings show a disconnect between parents and providers that she hopes can turn into stronger lines of communication and empathy going forward. Providers stated that they felt parents weren't always straightforward about the needs of their child because the parent was afraid their child would be turned away. On the other side, parents felt desperate to find care for their child so they could go to work.

"What we found was that really parents and providers both want to do the best thing for the children," Edwards said. "They're just both working in a system where they are being constrained and there is a lack of resources, and everyone is trying to survive and to get by."

Edwards also hopes the report will catch the attention of policymakers because "it's really up to them to make some of these changes, so that parents and providers can feel like they are on the same team and working together for the good of themselves," she said. More public funding is needed to solve the systemic issues that are exacerbated when families require specialized needs beyond the minimum level of care.

Sunshine Pediatric Day Center, a medical day facility that provides skilled nursing to patients with complex medical diagnoses, opened in August in Forest Hill, southeast of Fort Worth. The center can serve up to 60 patients from infant age up to 21 years old. The services and therapies are provided through Medicaid.

The center provides transportation to children and gives them a full day of care, allowing parents to work while their child is receiving medical care and therapies such as physical, speech and occupational. Among the current patients at the facility, some use a wheelchair, have a feeding tube or are oxygen-dependent, according to Claire Jones, chief operating officer.

"We take care of a lot of tracheostomy and a lot of gastrostomy-tube dependent patients," Jones said. A tracheostomy tube allows a patient to breathe through an opening in their neck and a gastrostomy tube allows food, water or medicine to be brought directly to a patient's stomach.

The Forest Hill location, which is one of four across Texas, is in the process of trying to make its services available to families with private insurance as well.

"There are many children with medical complexities that have commercial payers or mommy or daddy are working and have commercial insurance, and a lot of nursing services are not covered," Jones said.

Additionally, Jones hopes to soon open a classroom at the Fort Worth facility similar to the one at its Dallas location, which has a special education teacher from the school district.

Dorsey, the Fort Worth mother, said if Sunshine Pediatric Day Center was in the area when her son was younger, she could have potentially had a full-time job with the knowledge that her son was in a safe environment.

"I'm really excited to hear that the Sunshine Pediatric place has opened because it's hard to express just how precarious our life situation is," Dorsey said, referring to the constant battle of working enough hours to afford medical costs for her child while making too much to qualify for most kinds of government assistance.

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