Introduction
Research Questions
- How Many Children Under Age 6, Not Yet in Kindergarten, had One or More Conditions that Affect Care in 2012 and 2019?
- Who Provided Care for Children with and without Conditions that Affect Care in 2012 and 2019?
- What Proportion of CCEE Providers and Workforce Members Served Children with One or More Conditions that Affect Care, and How did this Vary by Funding Source?
- Did Center-based Workforce Members who Cared for Children with One or More Conditions that Affect their Care Receive Training to Support their Work with Such Children in 2019?
Obtaining high-quality child care and early education (CCEE) is difficult for many families. However, families with children who have an identified or suspected disability are particularly likely to face challenges in obtaining care. Many children require specialized services that are not available in every CCEE program, such as a one-on-one aide, speech therapy, occupational therapy, or accommodations for physical limitations or sensory challenges, among many other potential services.
To understand the experiences of children who need additional supports or accommodations for their care, the findings in this Snapshot use data from surveys of parents, CCEE providers, and CCEE classroom staff collected through the 2012 and 2019 National Surveys of Early Care and Education (NSECE). The NSECE surveysi asked respondents about children with a physical, emotional, developmental, or behavioral condition that affected the provision of care and/or prompted an Individualized Education Plan (IEP) or an Individualized Family Service Plan (IFSP). We therefore use the term “children with one or more conditions that affect their care” when referring to the children of interest in this Snapshot.1
1 The use of specific language when writing about disabilities is ever-evolving. The original Snapshot using the 2012 NSECE data referred to the population as “children with special needs.” However, according to the National Center on Disability and Journalism and the AP Stylebook, language using the word “special” when referring to disabilities should be avoided. The best option would be to describe specific disabilities or needs, and only when it is pertinent to the topic. The current AP Stylebook suggests using person-first language when referencing a population of people (i.e., children with one or more conditions that affect their care).
2 All statistical significance was based on two-tailed t-tests of the percentages with significant difference.
i Office of Planning, Research & Evaluation, Administration for Children & Families, U.S. Department of Health and Human Services. (n.d.) National Survey of Early Care and Education 2019. https://www.acf.hhs.gov/opre/project/national-survey-early-care-and-education-2019-2017-2022
ii A R Datta, Z Gebhardt, K Piazza, C Zapata-Gietl (2023). Children’s Participation in Child Care and Early Education in 2012 and 2019: Counts and Characteristics. OPRE Report No. 2023-118, Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/opre/project/national-survey-early-care-and-education-2019-2017-2022
iii Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services. (2020, January 22). Supporting Children with Disabilities ACF-IM-HS-20-01. Head Start Policy and Regulations. https://eclkc.ohs.acf.hhs.gov/policy/im/acf-im-hs-20-01
Purpose
The Snapshot examines the landscape of care in 2019 for children with one or more conditions that affect their care, exploring both where children received care and how prepared the CCEE workforce was to care for them. As the number of young children served under the Individuals with Disabilities Act has increased from 2012 to 2021, we also examine whether there have been changes in the landscape over that time.
Specifically, the Snapshot presents the following:
- The number of children under age 6, not yet in kindergarten, who have one or more conditions that affect their care, and the number of households with any such children
- Types of non-parental care used by children with one or more conditions that affect their care
- The proportion of CCEE providers who serve children with one or more conditions that affect their care (overall, and by public funding source)
- The proportion of center-based workforce members who work mostly with children with one or more conditions that affect their care
- The topics of professional development activities recently accessed by workforce members who primarily work with children with one or more conditions that affect their care
When possible, analyses include descriptive statistics for the 2019 data as well as statistical tests comparing findings from 2012 and 2019.
Key Findings and Highlights
- In 2019, 6.4 percent of children under age 6, not yet in kindergarten, were reported as having one or more conditions that affect their care. Overall, 7.9 percent of households reported that they had at least one child with one or more conditions that affect their care.
- From 2012 to 2019, the percentage of children reported as having one or more conditions that affect their care was relatively stable (5.3% vs. 6.4%). There was a statistically significant2 increase from 2012 to 2019 in the percentage of households with at least one child who had one or more conditions that affect their care (6.4% vs. 7.9%).
- From 2012 to 2019, there was a statistically significant shift toward children with one or more conditions that affect their care using parental care only (18.8% in 2012, 26.5% in 2019) rather than using regular CCEE. The proportion of children using unpaid care from an individual, such as a family member, friend, or neighbor, doubled during the same time frame (11.3% to 21.7%), whereas use of center-based care showed a statistically significant drop (25.2% to 17.3%).
- In 2019, over two thirds of all center-based CCEE providers served a young child with one or more conditions that affect their care (69.1%). When investigating providers with different funding sources, providers that did not receive funding from CCDF, Public pre-K, or Head Start had the lowest rate of serving young children with one or more conditions that affect their care (53.9%). Providers that received funding from both Head Start and Public pre-K had the highest rate of serving such children (95.8%).
- In 2019, 10.8 percent of center-based workforce members reported working mostly with children with one or more conditions that affect their care, which represented a statistically significant increase from 8.4 percent of members of the center-based workforce in 2012.
- In 2019, almost one quarter (24.4%) of listed home-based providers reported serving children with one or more conditions that affect their care. Smaller percentages of unlisted paid and unlisted unpaid home-based providers reported serving such children (18.5% and 11.6%, respectively). These percentages did not change substantially from 2012.
- Among workforce members who primarily worked with children with one or more conditions that affect their care, the most common recent training topic was social-emotional growth/behavior. Of these workforce members, 43.5 percent receiving such training, compared to 32.7 percent of workforce members who did not primarily work with children who had one or more conditions that affect their care.
Methods
Analyses were conducted with public use data files from the 2012 and 2019 NSECE. See the “Data Source” box for more information. Analyses included descriptive statistics for the 2019 data as well as analyses comparing findings from 2012 and 2019, where possible.
We were unable to compare 2012 and 2019 results on the number of center-based providers who work with children with one or more conditions that affect their care because the question in 2012 asked about all children in the program, whereas the question in 2019 asked about children ages 0-5.
In addition, the public-use data file for the 2019 Home-based Provider survey included two items intended to identify respondents who cared for children with one or more conditions that affect their care, whereas the public-use data file for 2012 included just one of these two items (the other item was available in the restricted-use data file; see Table 1). To be as inclusive as possible when calculating the 2019 estimate of the number of home-based providers caring for children with one or more conditions that affect their care, we used both survey items. To compare estimates from 2012 and 2019, however, we based estimates on the single question that was present in both the 2012 and 2019 public-use data files (i.e., children with an “emotional, developmental, or behavioral condition”).
T-tests were conducted to examine changes between 2012 and 2019; the changes reported as statistically significant in this Snapshot were found to be different at p < .05.
Conclusion
In 2019, 7.9 percent of households in the U.S. included a child with one or more conditions that affect their care—up from 6.4 percent in 2012. Overall, the patterns of care usage for children with one or more conditions that affect their care changed significantly from 2012 to 2019. During this time frame, there were significant increases in the percentage of such children using parental care only or unpaid individual care only. At the same time, there were significant decreases in the percentage of children with one or more conditions that affect their care using center-based ECE only or paid individual care only. In contrast, previously published analyses of the 2012 and 2019 NSECE that did not restrict the sample to children with one or more conditions that affect their care found that care usage patterns were relatively stable from 2012 to 2019. In fact, the only significant change for all children included in the NSECE from 2012 to 2019 was an increase in the percentage of children in other organizational CCEE.ii
There were some surprising patterns in 2019 regarding center-based providers’ funding sources and the percentage of centers serving children with one or more conditions that affect their care. Specifically, we expected all centers with any Head Start funding to serve at least one child with one or more conditions that affect their care. We found that centers with both Head Start and public pre-K funding were the largest percentage of centers serving children with one or more conditions that affect their care (95.8%). Centers with only Head Start funding and centers with only public pre-K funding were the next largest percentage of centers serving children with one or more conditions that affect their care, at 85.9 percent and 84.8 percent, respectively. Centers with no funding from CCDF, Head Start, or public pre-K were the lowest percentage of centers serving children with one or more conditions that affect their care, at 53.9 percent. Future research could seek to better understand the Head Start-funded programs that reported not currently serving children with one or more conditions that affect their care, given that Head Start programs have a requirement to prioritize the enrollment of children with a disability.iii Further, more work is needed to understand what programs and supports are specifically needed to serve children with one or more conditions that affect care.
Citation
McDoniel, M.E., Richards, K., & Madill, R.A. (2025). Child Care and Early Education for Children with Conditions that Affect Care. OPRE Report #2025-095. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
Quick Fact Images
Figure 2. Percent of Children by Type of Care in 2019, by Whether Children have One or More Conditions that Affect Care
Source. 2019 NSECE Household Survey.
Dark Blue: Percentage denominators are all children under age 6, not yet in kindergarten with one or more conditions that affect their care.
Striped: Percentage denominators are all children under age 6, not yet in kindergarten, without conditions that affect their care.
Glossary
- Child care and early education (CCEE):
- Caregiving and educational services for children from birth to age 13. CCEE includes center- and home-based settings for infants, toddlers, preschool- and school-aged children. CCEE refers to services for a larger age group than early care and education.
- NSECE:
- National Survey of Early Care and Education
- Children with one or more conditions that affect their care:
- A comprehensive definition of children represented in the Snapshot based on the range of items used in the NSECE questionnaires, including children with physical, emotional, developmental, or behavioral conditions; children with an IEP or IFSP; and children with mental, physical or other disabilities or delays.
- CCDF:
- The Child Care and Development Fund is a child care subsidy program.
- Head Start:
- Head Start programs serve families with children from birth to age 5, as well as pregnant women and expectant families who meet the federal low-income guidelines—that is, whose incomes are at or below the federal poverty guidelines or who receive Temporary Assistance for Needy Families, Supplemental Security Income, or Supplemental Nutrition Assistance Program public assistance services.
- Public pre-K:
- A program sponsored by state or local pre-K funding that provides publicly funded early education typically for children ages 3 to 5.
- Listed home-based provider:
- Individuals who appear on state and national lists of ECE providers and provide care at least five hours weekly in a home-based setting for children who are not their own.
- Unlisted home-based provider:
- Individuals, both paid and unpaid, who do not appear on state and national lists of ECE providers but provide care at least five hours weekly in a home-based setting for children who are not their own.