Prevalence and Characteristics of Home-Based Child Care Providers Serving Children With Provider-Reported Disabilities

Abstract

This study examines the prevalence of home-based child care providers who report serving at least one child whom they identify as having a disability. Although many families choose home-based child care, researchers know very little about how many home-based providers care for young children with disabilities. Through secondary analysis of the National Survey of Early Care and Education (NSECE) data about home-based child care providers, we examined the prevalence and predictors of serving children with provider-reported disabilities among listed and unlisted home-based providers. Descriptive analyses showed that 21.7% of listed providers, 20.5% of unlisted paid providers, and 10.1% of unlisted unpaid providers reported serving at least one child whom they identified as having a disability. These providers reported relatively low rates of connecting families to outside resources and utilizing outside resources to support them in their work with children. Providers who reported higher enrollment and who received child care subsidies were more likely to report serving a child with a disability.

Keywords

home-based child care children with disabilities family child care professional development early childhood education

Families of young children with disabilities have identified child care as an important support needed for families’ economic sustainability as well as respite (Booth & Kelly, 2004; Houser et al., 2014). Past research suggests that many children with disabilities spend time in nonparental child care; however, we have scarce contemporary research on the types of child care services accessible to young children with disabilities or the supports available to this group of child care providers. Moreover, nonparental child care is a diverse landscape of programs with wide variation in program quality and licensure requirements. According to the National Survey on Early Care and Education (NSECE), home-based child care (HBCC) is the most prevalent form of nonparental care in the United States, yet this care setting is also the most understudied (NSECE Project Team, 2015b). Of the research about child care for children with disabilities, only a very small amount has included HBCC providers. Therefore, there are many questions about how prepared HBCC providers are to serve children with disabilities, how frequently HBCC providers care for young children with disabilities, and the quality of children’s experiences in HBCC.

Defining HBCC

Recent data suggest that approximately 7 million children from birth to five regularly attend HBCC (Laughlin, 2013; NSECE Project Team, 2015b), including a disproportionately high number of families with infants and toddlers, single-parent households, minority families, and low-income families (Maher & Joesch, 2005; NICHD Early Child Care Research Network, 2004). There are approximately 3.7 million home-based providers in the United States, and HBCC arrangements make up the majority of child care arrangements in the United States (Paschall & Tout, 2018).

Generally, HBCC includes any nonparental care taking place in a residential setting. This includes both regulated arrangements like licensed family child care and informal care arrangements, which are often called kith and kin care or family, friend, and neighbor care.

HBCC providers may be paid or unpaid and may care for related or unrelated children (NSECE Project Team, 2015b). Definitions of HBCC can be unclear because of the wide variety of providers caring for children in residential settings and because of differences in state regulations. For example, some states require providers to be licensed when they care for at least one unrelated child, and other states regulate at three unrelated children or even more. These differences in state regulations regarding HBCC result in different definitions of HBCC by state and challenge the field in making cross-state or national comparisons.

Because of the challenges of categorizing HBCC providers from state to state, a mutually exclusive classification system for home-based providers was developed for use in the NSECE, a National Survey of Early Care and Education (NSECE) arrangements conducted in 2012. The NSECE classified HBCC providers as listed or unlisted (NSECE Project Team, 2013). Listed providers are providers who are found on a state or national list of child care providers, such as a list of licensed, license-exempt, or accredited providers. Unlisted providers do not appear on a list. This unlisted group was further divided into unlisted paid, those who receive payment for at least one child in their care from any source, and unlisted unpaid, those who receive no payment. The NSECE found that there are about 118,000 listed providers, 919,000 unlisted paid providers, and 2.7 million unlisted unpaid providers in the United States (NSECE Project Team, 2015b).

Factors That Influence Families’ Selection of HBCC

Previous research on child care selection suggests that many families prefer having their children cared for in HBCC settings. This preference may stem from the relationships that exist among families, children, and providers. The NSECE Project Team (2015b) reported that many unlisted HBCC providers are related to the children and families they serve. Even when families are unrelated to providers, some express a preference for HBCC because the setting offers opportunities for individualization and strong relationships with one consistent caregiver. This is particularly true for families of infants and toddlers (Coley et al., 2014; Layzer & Goodson, 2006). Families may also select HBCC because they prefer mixed-age settings that promote a more home-like environment and can serve siblings together in one place (Hallam & Hooper, 2016).

In addition, there are practical reasons families select HBCC settings. HBCC providers are often more flexible than center-based care as it relates to caregiving hours and schedules. For families that work evenings and weekends, HBCC providers may provide care during times that are not accessible in other types of caregiving settings. HBCC providers are much more likely than center-based providers to provide care during nonstandard hours and are more likely to adjust their caregiving schedules to meet parent work demands (NSECE Project Team, 2015a).

Child Care for Young Children With Disabilities

The American with Disabilities Act (ADA) requires that licensed child care programs make reasonable accommodations for children with disabilities (Americans with Disabilities Act of 1990, 2018). Moreover, the joint position statement of the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC; DEC/NAEYC, 2009) states the importance of inclusive practice for young children with disabilities across all types of early care and education settings. The definition of inclusion consists of access, participation, and supports for young children with disabilities and serves as a framework for increasing the quality of children’s experiences in child care settings, including HBCC.

Early intervention services for young children with disabilities, which include services like physical therapy, speech-language therapy, and occupational therapy, should be embedded into children’s natural routines and in their natural environments (DEC, 2014; DEC/NAEYC, 2009). For many children with disabilities, this natural environment is a nonparental child care setting. Although families of young children with disabilities often report a need for nonparental child care, we know relatively little about their child care arrangements. In a study of Early Head Start participants, low-income families of infants and toddlers with and without disabilities reported similar child care utilization rates at 14, 24, and 36 months (Wall et al., 2006). However, parent satisfaction with care varied, with parents of children with disabilities reporting lower satisfaction rates and low-quality care than parents of children without disabilities. In a four-state study of the child care needs of families with young children, families of children with disabilities reported enrolling their child in child care approximately 6 months later than children without disabilities (Knoche et al., 2006). In this same sample, parents with children enrolled in center-based programs perceived their child care programs as higher quality than families enrolled in HBCC. Moreover, parents of young children with disabilities reported more frequent child care changes (Knoche et al., 2006).

The extent to which HBCC providers care for children with disabilities is largely unknown. A recent study from Costanzo and Magnuson (2019) using data from the National Household Education Surveys Early Childhood Participation Program found that children with disabilities were more likely to receive care in center-based settings than in informal settings. However, the authors noted that this finding may relate to the increased likelihood of children receiving developmental screening and follow-up services in center-based settings, which in turn may lead to earlier and more frequent identification of disabilities (Costanzo & Magnuson, 2019).

A few studies have documented the use of HBCC among the parents of children with disabilities (e.g., Booth & Kelly, 2002; K. Smith, 2002). A case study of four home-based providers serving children with disabilities found that these providers started caring for a child with a disability because the child was a sibling of a child for whom they were already caring or because the provider had agreed to serve the child before the parents revealed the disability. The providers reported that they learned to care for children with disabilities on their own rather than through training or education (Devore & Hanley-Maxwell, 2000). In center-based care, inclusion of children with disabilities has been linked to higher observed quality (Hestenes et al., 2008), but the opposite has been found in family child care settings (Knoche et al., 2006).

Previous research exploring child care providers’ attitudes about and preparation for caring for children with disabilities has primarily focused on center-based child care providers. In a statewide survey of early intervention and child care providers serving infants and toddlers (of which 27% were HBCC), Weglarz-Ward et al. (2019) found that most child care providers reported favorable attitudes about inclusion. Moreover, child care providers in this sample were more likely to report that young children with disabilities should be cared for in inclusive settings as compared with early intervention providers. Essa and colleagues (2008) found that child care providers who had taken some coursework related to inclusion were more likely to serve children with disabilities. Generally, center-based providers have reported more positive views about inclusion than home-based providers, and they were more likely to report serving children with disabilities (Mulvihill et al., 2002). Recent research on HBCC providers’ perceptions of serving children with disabilities is scarce. However, research from the 1990s found that when home-based providers had personal experiences with children with disabilities, they were more likely to provide inclusive care (Buell et al., 1999; Dinnebell et al., 1998).

Child Care Linkages With Early Intervention and Other Community Resources

Previous research has found that accessing outside community and educational resources can be very beneficial to HBCC providers in their work and increasing their quality (Bromer et al., 2009; Forry et al., 2013; Gable & Halliburton, 2003). Most states have professional development resources or quality improvement initiatives that include formal HBCC, such as licensed family child care providers. However, HBCC providers tend to have fewer supports available compared with center-based providers. When supports are available, HBCC providers may face barriers in accessing them due to linguistic, scheduling, and transportation challenges (Gable & Halliburton, 2003; Hallam et al., 2017).

More recent policy and child care regulation have increased professional development requirements for HBCC. For example, the reauthorization of CCDBG (Child Care and Development Block Grant Act of 2014, 2014) includes new professional development requirements in the areas of health and safety that home-based and center-based providers must meet to participate in the child care subsidy program. The emergence of Quality Rating and Improvement Systems (QRIS) may also require additional professional development requirements for listed home-based providers. However, research related to QRIS indicates that listed HBCC providers are less likely to participate in QRIS, less likely to access the assistance provided through QRIS, and more likely to be rated at lower quality levels (Hallam et al., 2017; S. Smith et al., 2010; Tout et al., 2010).

Professional collaboration between child care providers and early intervention providers is important to ensuring high-quality support for young children with disabilities. However, one study found that center-based and HBCC providers reported having limited opportunities to meaningfully collaborate with early intervention providers (Weglarz-Ward et al., 2020). Improving this collaboration may be especially important to ensuring HBCC can effectively serve children with disabilities. HBCC providers tend to work in isolation and have limited formal education in child development or early education (Rusby, 2002; Schaack et al., 2017; Tuominen, 2003; Whitebook et al., 2004). This is especially true for providers in rural communities (Magnuson & Waldfogel, 2005; Maher et al., 2008). Thus, it is important to understand the availability and access of community and educational resources available to HBCC that could enhance inclusive caregiving opportunities for young children with disabilities.

Overall, we know very little about the prevalence of inclusive care in HBCC settings or the preparation and support of these caregivers that may assist them in providing high-quality care. In addition, little research has been conducted about how and if HBCC providers access outside educational and community resources to support inclusive child care.

National Data Related to HBCC

The NSECE provides a unique opportunity to examine a national sample of HBCC providers who report serving young children with disabilities. This study was funded by the Office of Planning, Research, and Evaluation (OPRE) in the Administration of Children and Families (ACF), U.S. Department of Health and Human Services. The purpose of the NSECE was to provide an in-depth picture of early childhood education in the United States, including a description of the workforce, the availability and use of care, and families’ preferences related to care arrangements (NSECE Project Team, 2013). The NSECE provided the first national portrait of child care availability and included data on the use of all forms of nonparental care. Specifically, it provided the first and only nationally representative sample of home-based providers. More information about the NSECE, including the sampling, procedures, and questionnaires used, is available at https://www.acf.hhs.gov/opre/research/project/national-survey-of-early-care-and-education-nsece-2010-2014.

This study uses NSECE data to explore four research questions. Because of features of the NSECE design described further in the methods section (NSECE Project Team, 2015c), as well as research about the distinctions between listed and unlisted providers and between paid and unpaid providers (NSECE Project Team, 2015b), we answered our first three research questions using the HBCC provider classifications of listed, unlisted paid, and unlisted unpaid. Conceptualizing HBCC providers into these three groups, we posed the following descriptive research questions:

Research Question 1: For each of the three HBCC provider groups, what is the prevalence of providers who report serving children whom they identify as having a disability?

Research Question 2: For each of the three HBCC provider groups, what are the characteristics of providers who report serving children whom they identify as having a disability relative to those who do not report serving children with disabilities?

Research Question 3: For each of the three HBCC provider groups, what community resources do those who report serving children with disabilities say that they access?

We then posed a fourth research question that was predictive in nature. For this question, we combined unlisted paid and unlisted unpaid providers into one group of unlisted providers, which allowed us to examine payment as a predictor variable:

Research Question 4: What enrollment and provider characteristics predict listed and unlisted HBCC providers’ report of serving children whom they identify as having a disability?

Method

Sampling

The NSECE used a multistage probability sample design. This included first identifying and sampling primary sampling units (PSUs). The PSUs represented the 50 states and District of Columbia. The number sampled in each state was based upon the population of children under 18 years in that state. Next, secondary sampling units (SSUs) were selected. SSUs with a high percentage of low-income households were oversampled during this stage to ensure the experiences of low-income families were adequately captured. Because of this multistage probability design and the oversampling of SSUs with low-income households, a sample weight is provided in the data set for each NSECE survey to allow the generation of nationally representative estimates.

For this study, we analyzed data from the public-use home-based provider survey. The survey of home-based providers used a three-part classification of providers described previously: listed, unlisted paid, and unlisted unpaid. The sampling frame of listed providers was created through compiling all available state and national administrative lists that contained home-based providers within the selected SSUs. These included lists of licensed, regulated, license-exempt, and registered providers from licensing and child care subsidy agencies, Head Start, and public pre-kindergarten within the selected SSUs. Listed providers were eligible to be included in the sample if they reported caring for at least one noncustodial child in a residential setting. Generally, this category included licensed and license-exempt family child care providers (NSECE Project Team, 2015b).

Because the majority of HBCC providers are not licensed or regulated and therefore cannot be found on state and national lists, it was necessary to develop a procedure for identifying and surveying unlisted HBCC providers. Unlisted providers were identified using a household screener used with households within the selected SSUs. If a member of the household reported that someone in that household provided nonparental care for at least 5 hr per week, the caregiver was invited to complete the home-based provider survey. The category of unlisted providers included family members and friends who look after children, as well as other home-based providers who are not licensed or registered with the state. The unlisted category was further divided into unlisted paid and unlisted unpaid. Unlisted paid providers were those who received payment for at least one child in their care. Payment could come from parents, government, or private funding sources. For example, relatives and neighbors receiving private or government payment and nannies were classified as unlisted paid providers in the NSECE. Unlisted unpaid providers received no payment for any child in their care. This includes neighbors, relatives, or other adults who did not receive payment from any source for caring for children (NSECE Project Team, 2015b).

The sample for our analysis was drawn from the public-use NSECE data set of home-based providers. A total of 3,934 listed and 2,052 unlisted home-based providers completed the provider questionnaire. The weighted response rate for listed and unlisted home-based providers was 80.7% and 67.7%, respectively. We excluded providers who did not provide information about whether they were serving a child with a disability (n = 37). Our final analytic sample included 3,897 listed providers, 535 unlisted paid providers, and 1,517 unlisted unpaid providers. We used the sample weight provided in the home-based provider data set in all analyses to generate nationally representative estimates.

Procedure

Data for the home-based provider survey were collected using interviews. These interviews were conducted using multiple methodologies, including online, telephone, and in-person, to maximize the response rate. The home-based survey took about 20 to 35 min to complete, depending on provider type and enrollment. It included both open- and closed-ended questions. All data were collected through provider self-report. Providers were asked about a range of topics, including enrollment, rates charged, activities with children, qualifications, and household characteristics and demographics.

Measures

Provider-reported disability status

The NSECE measured disability status by providers’ self-report of how many children they serve who have an emotional, developmental, or behavioral condition that affects the way the provider cares for them. We used this variable to calculate whether providers serve any children with disabilities and the percentage of children enrolled with disabilities. Notably, because this variable is based on providers’ own report of children’s disability status and is not verified by documentation of formal identification of disabilities, it is likely influenced by providers’ own perceptions and knowledge of typical child development. Therefore, when we say providers who serve children with disabilities, it refers to those providers who reported serving one or more children whom the provider identified as having a disability.

Program characteristics

Providers reported the total number of children for whom they regularly provided care. The NSECE defined regular as at least 5 hr of care per week. Providers reported if they had a prior personal relationship, which could be a blood or nonblood relative, family friend, or other acquaintance, with all of the children in their care. They reported whether they regularly served children in these age groups: birth to 5, birth to 3, 3 to 5, and school-age. They also reported if they served any children for whom they received payment from child care subsidies. We present descriptive statistics for the subsidy variable only for listed providers. This is because of the high percentage of missing data for unlisted paid providers and because unlisted unpaid providers by definition do not receive payment.

Provider characteristics

Providers reported their year of birth, which was used to calculate provider age, their years of experience, which is provided in the NSECE data as a categorical variable, and the number of additional years they plan to care for children, which is also categorical. They reported their household income, which is provided as both a continuous and categorical variable in the NSECE, with the continuous variable having a high percentage of missing data. Therefore, we analyzed the categorical variable.

Education

Providers reported their highest level of education, which was categorized as less than a high school diploma, a diploma or graduate equivalency degree (GED), some college, an associate’s degree, or a bachelor’s degree or higher. Listed providers were also asked if they had certification as either a special education teacher or elementary school teacher, and for providers that had at least some college, if their major was in early childhood education or a related field.

Motivation

Motivation for providing child care was measured using one question from the NSECE. Providers were asked to identify the main reason they cared for children, and responses were recorded verbatim and coded within the NSECE data set. We collapsed codes into four categories: (a) career-related, (b) to help children or parents, (c) to earn money, or (d) to have a convenient work arrangement. For example, if a respondent said that their main reason for providing care was as a step to a related career, that was coded as career-related. If they said that their main reason was to be able to work from home, that was coded as a convenient work arrangement.

Community characteristics

Providers’ neighborhoods were categorized as high-poverty (>20% of households below Federal Poverty Level), moderate poverty (13.9%–20% of households below Federal Poverty Level), or low poverty (<13.8% of households below Federal Poverty Level) based on 2010 U.S. Census data at the census tract level. The urban/rural classification was determined using 2005–2009 5-year averages in the American Community Survey. Census tracts were identified as having a high density of urban population (85% or more of urban to total distribution), moderate urban density (85%–30%), or high rural density (less than 29%).

Support to families

Providers were asked whether they had helped families access the following outside services in the last year: health screening, development assessments, therapy, counseling, and social services. We used an additional dichotomous variable that indicated if providers had referred families to any of these services in the last year. In addition, providers reported whether they provided care for children who were sick, whether they served children during nonstandard hours, which was defined as evenings, overnight, and weekends, and whether they allowed families flexibility in scheduling and payment.

Support for providers

Providers indicated whether they had access to a family support resource to help them with issues parents raise. They reported whether they had participated in professional development activities within the last year, including coaching or home visiting, coursework in higher education related to caring for children, and workshops. For providers who reported having participated in a workshop, they were asked if their most recent workshop was stand-alone or part of a series. They were also asked to identify the topic of the workshop. Topics were coded within the NSECE data into 12 categories, one of which was children’s special physical/emotional needs. In addition, providers reported how many hours during the last month they spent participating in professional development. To capture if providers were engaging in social support activities, we examined whether providers met with others who cared for children to receive support or share ideas. Listed providers were asked whether they had an affiliation with a provider network or were sponsored by an organization like Head Start, a church, or Catholic Charities.

Data Analysis

There are very large differences in sample weights between listed and unlisted providers due to the differences in the sampling approaches for listed versus unlisted providers. Therefore, the NSECE Project Team (2013) data documentation strongly advises researchers not to combine data for listed and unlisted providers in analyses. As stated in the user’s guide for the NSECE home-based provider data:

Because of these tremendous differences in sampling weights, we strongly recommend that all analyses of home-based providers treat listed and unlisted sample types separately. Combining cases from the two sample types is generally not supported by these data; the entire estimate for listed providers, for example, is often smaller than the standard error for the estimate for unlisted providers. (NSECE Project Team, 2015c, pp. 4–1)

We followed this recommendation and analyzed listed and unlisted providers separately.

In addition, unlisted unpaid and unlisted paid providers are likely quite different. For example, 96.5% of unlisted unpaid providers in the analytic sample had a prior relationship to all of the children in their care, compared with 63.4% of unlisted paid providers (NSECE Project Team, 2015b). Therefore, we analyzed listed, unlisted paid, and unlisted unpaid providers separately, which is similar to the approach used in other analyses of NSECE data (Hooper, 2018; NSECE Project Team, 2015a, 2015b), for the three descriptive research questions.

We examined descriptive statistics for the selected NSECE variables for the analytic sample. We used independent samples t-tests and chi-square tests to examine differences in provider, program, and community characteristics between those providers who reported serving children with provider-identified disabilities and those who did not. For categorical variables, we conducted post hoc testing using Bonferroni correction.

For the fourth research question, which used logistic regression to examine predictors of serving children with provider-identified disabilities, we combined unlisted paid and unpaid providers into one group of unlisted providers. This allowed us to include payment as a predictor variable in the logistic regression analyses. We conducted logistic regression separately for listed and unlisted providers. Provider report of serving a child with a provider-identified disability was the outcome variable. Total enrollment, whether all children had a relationship with the provider, whether the provider enrolled school-age children, providers’ years of experience and highest level of education, and whether the provider received payment and subsidies were included as predictors. For the logistic regression models, missing data on predictor variables were handled using multiple imputation. Twenty-five imputed data sets were created in SPSS, and results from pooled data sets are presented. We applied the sample weight provided in the data set in all analyses to ensure results are nationally representative.

Results

Results for the descriptive research questions are presented first, followed by the results of the logistic regression analyses used to answer the fourth research question.

Prevalence of Providers Who Report Serving Children With Provider-Identified Disabilities

Approximately 21.7% of listed providers, 20.5% of unlisted paid providers, and 10.1% of unlisted unpaid providers reported serving at least one child with a disability. On average, these providers reported serving one or two children with a disability. However, some listed providers reported a high number and percentage of children, up to 100%, as having disabilities.

Characteristics of Providers by Report of Serving Children With Provider-Identified Disabilities

The program, provider, and community characteristics of HBCC providers in the sample are shown on Table 1, presented separately for the three provider types. For each provider type, results are shown separately for providers who reported serving at least one child with a disability and those who did not. We included significance tests to identify statistically significant differences between these groups.

Table 1.

Provider, Program, and Community Characteristics of Listed, Unlisted Paid, and Unlisted Unpaid Home-Based Providers by Self-Report of Serving Children With Disabilities.

Program and Provider Characteristics	Listed (n = 3897)			Unlisted paid (n = 535)			Unlisted unpaid (n = 1,517)
Program and Provider Characteristics	Disability	No disability	Significance test	Disability	No disability	Significance test	Disability	No disability	Significance test
Program characteristics
Total enrollment	10.8 (6.1)	7.7 (4.1)	t = 14.03**	4.3 (2.9)	3.2 (2.6)	t = 3.12**	2.9 (2.1)	1.8 (1.3)	t = 6.76**
Care for children birth–2	93.9%	93.7%	χ ² = 0.06	62.2%	62.6%	χ² = 0.00	41.8%	40.3%	χ² =.14
Care for children 3–5	91.5%	85.1%	χ² = 22.99**	69.5%	48.0%	χ² = 12.32**	44.2%	40.4%	χ² =.86
Care for school-age children	80.3%	65.7%	χ² = 61.53**	75.3%	56.0%	χ² = 10.59**	75.4%	49.0%	χ² = 41.91**
Serve all relationship-based children	5.7%	11.3%	χ² = 22.89**	66.7%	62.8%	χ² = 0.45	91.7%	97.0%	χ² = 12.44**
Serve any children receiving subsidy	49.2%	28.6%	χ² = 103.03**	—	—	—	—	—	—
Provider Characteristics
Provider age	46.3 (10.5)	47.5 (11.2)	t = −2.75**	44.9 (13.2)	43.0 (14.2)	t = 1.08	48.5 (15.1)	51.2 (14.3)	t = −2.27*
Years of experience			χ² = 26.81**			χ² = 21.49**			χ² = 6.82*
Less than 10	31.4%	38.8%		48.8%	66.8%		62.6%	72.3%
10–20	43.8%	34.3%		25.0%	24.7%		17.8%	13.7%
More than 20	24.8%	26.9%		26.2%	8.5%		19.6%	14.0%
Number of additional years to provide care			χ² = 40.55**			χ² = 17.52**			χ² = 10.55*
0–1 years	3.6%	6.8%		8.5%	21.8%		8.8%	11.5%
2–4 years	17.4%	20.1%		26.8%	27.0%		16.8%	20.0%
5–9 years	20.5%	27.1%		11.3%	21.4%		13.9%	22.1%
10 or more years	58.6%	46.1%		53.5%	29.8%		60.6%	46.3%
Provider income			χ² = 12.77**			χ² = 7.96**			χ² = 0.54
Less than US$25,000	22.7%	29.3%		60.3%	48.0%		39.2%	36.2%
US$25,000–US$50,000	33.5%	31.5%		25.6%	22.3%		26.1%	27.9%
More than US$50,000	43.8%	39.2%		14.1%	29.8%		34.6%	35.8%
Highest level of education			χ² = 32.80**			χ² = 10.17*			χ² = 1.35
Less than high school	2.5%	7.2%		36.9%	20.6%		14.0%	14.8%
High school diploma/GED	25.5%	29.3%		21.4%	26.4%		27.4%	30.1%
Some college	36.5%	32.8%		19.0%	26.1%		26.2%	22.4%
Associate’s degree or higher	35.5%	30.8%		22.6%	26.9%		32.3%	32.7%
Major in ECE or related field	49.9%	36.5%	χ² = 33.23**	—	—	—	—	—	—
Certification in special/elementary education	6.6%	7.0%	χ² = 0.16	—	—	—	—	—	—
Child Development Associate (CDA)	42.4%	44.5%	χ² = 1.33	—	—	—	—	—	—
Main reason for caring for children			χ² = 1.78			χ² = 12.82**			χ² = 14.91**
Career-related	49.2%	51.1%		30.6%	16.7%		15.9%	7.2%
Help children or families	20.0%	19.2%		50.6%	60.8%		82.9%	90.7%
Earn money	9.8%	8.6%		16.5%	13.2%		0.0%	0.0%
Convenient work arrangement	20.9%	21.2%		2.4%	9.3%		1.2%	2.1%
Community characteristics
Community poverty density			χ² = 9.53**			χ² = 1.04			χ² =.45
High poverty	16.8%	18.4%		23.5%	27.4%		24.0%	24.9%
Moderate	23.7%	18.9%		27.1%	29.1%		22.2%	23.9%
Low	59.5%	62.6%		49.4%	43.5%		53.9%	51.2%
Urban/rural density			χ² = 19.35**			χ² = 2.55			χ² = 2.10
High urban	58.5%	50.3%		65.9%	72.8%		64.1%	68.5%
Moderate urban	28.3%	32.3%		21.2%	19.3%		22.2%	21.1%
High rural	13.2%	17.5%		12.9%	7.9%		13.8%	10.4%

Note. Independent samples t-tests used as significance test for continuous variables; chi-square tests used for categorical variable. HS = high school.

p < .05. **p < .01.

Overall, providers across the three groups reported a wide range of education levels, although a larger percentage of unlisted paid providers had less than a high school diploma compared with listed and unlisted unpaid providers. The unlisted paid providers also reported lower household income on average than the other groups of providers.

Program characteristics

Listed, unlisted paid, and unlisted unpaid providers who reported serving a child with a disability cared for more children than providers who did not report serving a child with a disability. On average, listed providers who reported serving young children with disabilities enrolled three more children than providers who did not report serving a child with a disability. Unlisted paid and unpaid providers who reported serving a child with a disability enrolled an average of one more child than those who did not report serving a child with a disability.

Providers who reported caring for a child with a disability across provider types were more likely than those not caring for a child with a disability to enroll preschool-aged and school-aged children. Listed and unlisted unpaid providers who reported serving a child with a disability were less likely to serve all children with whom they had a prior relationship, such as neighbors, friends, or relatives. Listed providers who reported serving a child with a disability were more likely to serve a child who received child care subsidy.

Provider characteristics

On average, listed and unlisted unpaid providers who reported caring for a child with a disability were younger. Across all three provider types, providers who reported caring for a child with a disability differed in their years of experience, as well as the number of additional years they planned to provide child care. Frequencies and post hoc testing indicated that providers caring for children with disabilities had more experience and planned to care for children longer. Results for household income varied by provider type. There were not significant differences for unlisted unpaid providers. For listed providers, more providers who reported serving a child with a disability had a household income of greater than US$50,000 than those who did not serve a child with a disability. However, fewer unlisted paid providers serving a child with a disability had a household income of greater than US$50,000 than those who did not serve a child with a disability.

Results show that among listed and unlisted paid providers, those who served children with disabilities differed from those who did not in their level of education. Frequencies and post hoc testing indicated that listed providers serving children with disabilities reported higher education levels than those not serving children with disabilities. For listed providers, we were also able to examine their major and area of certification. Providers who reported serving a child with a disability were more likely to have a major in ECE or a related field. The rates of certification in special or elementary education and having a Child Development Associate did not differ significantly by providers’ reports of caring for children with disabilities. Unlisted paid providers serving children with disabilities reported having less than a high school diploma at a significantly higher rate than those not serving a child with a disability, 36.9% and 20.6%, respectively.

Paid and unpaid unlisted providers differed in their main reason for caring for children by whether they reported caring for a child with a disability. Providers who reported caring for children with disabilities more frequently reported a career-related reason than those who did not report caring for children with disabilities.

Community characteristics

Poverty density and urban density of the provider’s neighborhood differed significantly by disability status of children enrolled only for listed providers. Those who reported caring for a child with a disability were more likely to live in neighborhoods with moderate levels of poverty and more likely to live in neighborhoods that were moderately urban or highly rural.

Access to and Utilization of Resources

To answer the third research question, we examined descriptive statistics about the types of resources providers offered to families and accessed themselves for the samples of listed, unlisted paid, and unlisted unpaid providers who reported serving at least one child with a disability. Results are displayed on Table 2.

Table 2.

Frequency of Utilizing Resources among Listed, Unlisted Paid, and Unlisted Unpaid Home-Based Providers Who Reported Caring for Children With Disabilities.

Resource Variables	Listed providers(n = 989)	Unlisted paid providers(n = 100)	Unlisted unpaid providers(n = 173)
Resources to support families
Refer families to any outside service	68.8%	54.1%	47.9%
Total number of outside services referred	1.9 (1.8)	1.4 (1.7)	1.3 (1.7)
Health screenings	39.3%	34.1%	34.8%
Developmental assessments	51.6%	32.9%	32.1%
Therapeutic services	43.6%	30.5%	18.8%
Counseling services	26.1%	20.7%	27.9%
Social services for parents	31.1%	25.6%	18.2%
Offers care for sick children	40.4%	71.2%	72.4%
Nonstandard hours	40.1%	90.9%	96.7%
Flexible payment and scheduling	48.9%	—	—
Resources to support providers
Family support resource	55.0%	41.2%	38.8%
Coaching	40.4%	20.0%	16.4%
Coursework	34.5%	13.1%	8.5%
Attend a workshop
None	15.4%	78.8%	84.2%
Single	54.9%	8.2%	9.1%
Series	29.7%	12.9%	6.7%
Professional development hours per month	1.1 (2.1)	0.3 (0.7)	0.1 (0.2)
Meet with others
No	39.4%	36.6%	51.5%
Yes, but not regularly	29.9%	23.2%	19.4%
Yes, regularly	30.7%	40.2%	29.1%
Affiliation		—	—
None	74.8%	—	—
Provider network	21.1%	—	—
Sponsored by an organization	4.1%	—	—

Resources to support families

Over half of listed and unlisted paid providers and slightly less than half of unlisted unpaid providers reported that they had referred families to some type of outside service in the last year. Of the five services asked about in the NSECE, listed providers most frequently reported helping parents access developmental assessments and therapeutic services. Unlisted paid and unpaid providers most frequently reported helping parents access health screenings and developmental assessments. However, less than half of providers reported having referred families to these services in the last year.

Frequencies indicate that unlisted providers offered care for sick children and provided care during nonstandard hours at higher rates than listed providers. Less than half of listed providers reported serving children during nonstandard hours, compared with 90.9% of unlisted paid and 96.7% of unlisted unpaid providers.

Resources to support providers

Listed providers reported accessing resources at a higher rate than unlisted paid and unpaid providers. This was true for accessing a family support resource and participating in coursework, coaching, and workshops. Of the providers who attended a workshop, 11.1% of listed providers, 16.8% of unlisted paid providers, and 48.4% of unlisted unpaid providers reported that their most recent workshop was focused on caring for children with special physical or emotional needs. Listed providers also reported spending more time in professional development each month. Listed and unlisted paid providers had similar rates of meeting with others, with more unlisted paid providers reporting meeting with others regularly rather than occasionally. Among listed providers, 74.8% reported no affiliation with a network or sponsor organization. These data were not available for unlisted providers.

Predictors of Serving Children With Provider-Reported Disabilities

To address Research Question 4, we conducted logistic regression analyses separately for listed and unlisted providers. Table 3 shows the results of the logistic regression models for these two provider groups. The models for listed providers and unlisted providers explained 14.0% and 10.5% of the variance in the outcome using Nagelkerke R², respectively.

Table 3.

Predictors of Listed and Unlisted Providers Report of Serving a Child With a Provider-Identified Disability.

Predictor Variables	Listed			Unlisted
Predictor Variables	B	SE	Exp(B)	B	SE	Exp(B)
Total enrollment	0.093	0.009	1.097***	0.166	0.037	1.181***
All relationship-based	–0.442	0.193	0.642*	0.237	0.260	1.267
Enroll school-age children	0.469	0.111	1.598***	0.826	0.167	2.283***
Years of experience
Less than 10	Reference
10 to 20	0.233	0.107	1.262*	0.086	0.190	1.090
20 or more	0.099	0.118	1.104	0.594	0.184	1.810**
Provider education
HS Diploma or less	Reference
Some college	0.115	0.120	1.122	0.145	0.177	1.157
Degree in ECE or related field	0.277	0.139	1.319*	–0.236	0.891	0.790
Degree, not in ECE or related field	–0.071	0.174	0.931	0.153	0.505	2.613
Receive payment	–	–	–	0.432	0.175	1.541*
Receive subsidies	0.718	0.119	2.050***	–	–	–

Note. Dependent variable = Enrollment of at least one child with a provider-identified disability. HS = high school.

p < .05. **p < .01. ***p < .001.

Across both groups, increased enrollment predicted a higher likelihood of serving at least one child with a provider-reported disability. Similarly, caring for school-age children was associated a higher likelihood of serving a child with a provider-reported disability in both groups. Unlisted providers who reported serving school-age children were 2 times more likely to report caring for a child with a disability.

The remaining predictors that emerged as significant differed across listed and unlisted providers. For listed providers, serving all children with whom they had a prior personal relationship was associated with decreased likelihood of caring for a child with a provider-identified disability. Having 10 to 20 years of experience compared with less than 10 years was associated with a higher likelihood of caring for a child with a provider-identified disability. Providers with a degree in ECE or a related field compared with a high school diploma or less were more likely to report serving a child with a disability. Those who received child care subsidies for one or more children were 2 times more likely to report serving a child with a disability.

Among unlisted providers, those with 20 or more years of experience were almost 2 times more likely to report serving a child with a disability. Unlisted providers who received payment were also more likely to report serving a child with a disability.

Discussion

HBCC is an important sector of child care, as it serves more than half of children who receive nonparental care in the United States (NSECE Project Team, 2015b). However, we know very little about how it is accessed by families of children with disabilities in the United States. This study provides the first nationally representative depiction of the prevalence of HBCC providers who report serving children whom they identify as having disabilities. The NSECE data have significant limitations, namely, the lack of a clear definition of disability status and reliance of providers’ self-report of children’s disability status. Despite these limitations, the data provide an important portrait of the frequency and characteristics of HBCC providers who report serving children whom they identify as having a disability upon which further research can build.

It is notable that about 20% of listed and unlisted paid providers reported serving at least one child with a disability. The percentage of unlisted unpaid providers who reported serving children with disabilities was lower. Given that there are 3.7 million HBCC providers nationwide, these results suggest that a high number of children with disabilities receive care in home-based settings. Moreover, this prevalence suggests that more policy and research attention to this sector of child care is needed to ensure HBCC providers have the resources and professional support needed to adequately serve children with disabilities. High-quality child care programs can be ideal settings for early intervention (Weglarz-Ward et al., 2020), but the lack of an integrated system of child care and early intervention has led to fragmented and distinct systems that often do not work well together. Strategies such as increasing funding for the Individuals with Disabilities Act (IDEA), increasing pay for the child care workforce to support retention of qualified child care providers, and requiring states to expand inclusive child care may help better integrate child care and early intervention (Novoa, 2020).

Prior research suggests that some families prefer HBCC for their children because of the unique caregiving that HBCC affords (Coley et al., 2014; Layzer & Goodson, 2006). Recently, a national examination of parental perspectives using the NSECE found that parents of young children without disabilities and those with children with disabilities did not differ in their preferences and attitudes about child care settings (Riser & Hallam, 2020). More research in this area is warranted to determine family perspectives on the use of different types of caregiving arrangements and to determine how family preferences could influence the delivery of early intervention services. The inclusion of family voices could assist states in expanding the ways in which HBCC are supported in serving children with disabilities.

The small group sizes, low ratios, and continuity of care, along with availability of care during nonstandard hours, make HBCC a promising child care setting for young children with disabilities (Hallam & Hooper, 2016; Layzer & Goodson, 2006; NSECE Project Team, 2015a, 2015b). Families of young children with disabilities are often navigating complex health and education systems. The stability of HBCC may be appealing to families and offer much-needed individualized attention and care. However, low levels of formal education are a concern, especially among unlisted paid providers. Past national research has noted that listed home-based providers tend to have lower educational levels than center-based teachers (Bassok et al., 2016). Our findings suggest that listed providers who reported serving children with disabilities had higher education levels and were more likely to have bachelor degrees, specifically degrees in early childhood, than providers who did not report serving children with disabilities. Although this is promising, our findings suggest a need for more attention to preparation for the heterogeneous group of HBCC providers serving young children with disabilities.

Ongoing professional development is also an important issue for consideration. Our findings suggest low levels of engagement in professional development among both unlisted paid and unpaid providers. In comparison, listed providers much more frequently reported having attended a workshop in the last year. Unfortunately, there are no data in the NSECE about the content of the workshops accessed by these caregivers other than the topic of the most recent workshop they attended. Even so, these data give us a sense of how HBCC are utilizing state systems of professional development and quality improvement, which may in turn promote high-quality services to all children, including children with disabilities.

Although unlisted unpaid providers reported an especially low rate of workshop attendance in the last year, it is notable that among those who attended a workshop, almost half reported that the topic of their most recent workshop was caring for children with special physical or emotional needs. This suggests that they may be seeking out opportunities to learn about caring for children with disabilities and may be interested in utilizing additional supports if they were available.

State requirements for professional development and licensing of child care providers vary significantly. However, all HBCC providers need access to professional development that supports inclusive practice and that responds to the unique context of home-based settings. As states build and modify professional development systems and initiatives for both listed and unlisted HBCC providers, more attention is needed to the provision of high-quality care for all children, including children with disabilities.

Taken together, our study findings suggest that HBCC providers would benefit from additional professional development on inclusion and providing services to young children with disabilities. This could include offering funding for technology and materials through QRIS that help providers modify their caregiving environments, connecting HBCC providers to early intervention resources and community organizations where they can network with others and receive additional support, and providing group and onsite individual training and professional development about inclusion through state professional development systems. Little is known about the current availability and quality of in-service professional development for HBCC as it relates to serving children with disabilities and their families. States may need to take stock of the types of professional development opportunities available to HBCC and ensure that this caregiving sector has access to professional learning experiences that enhance their care for young children with disabilities.

High-quality, inclusive services for young children with disabilities are determined by appropriate access, participation and support and are not bound by setting (DEC/NAEYC, 2009). HBCC is a viable setting for inclusive practice if the provider is appropriately prepared and supported throughout the process (Hallam & Hooper, 2016). DEC (2014) identified seven domains of key practices that are essential to high-quality services for young children with disabilities: assessment, environment, family, instruction, interaction, teaming and collaboration, and transition. These essential dimensions of practice can provide a framework for building professional development, itinerant services, and other supports for HBCC providers. Given the relatively high numbers of HBCC providers who report serving children with disabilities, consideration for this caregiving setting is needed relative to the delivery of early intervention and special education services. Models of collaborative teaming and itinerant services could be extended, examined, and made accessible to HBCC settings (e.g., DEC, 2014; Rush & Shelden, 2012).

HBCC who enrolled more children and who served school-age children in addition to young children were more like to report serving children with disabilities. It is unclear if this finding is related to provider perceptions of disability (e.g., are HBCC providers who serve more children more likely to identify a child has having a special need?) or if other familial factors are at play, such as caregiving for children with disabilities and their siblings. More research is needed to understand this finding and specifically to examine HBCC provider perspectives of disability and need for services.

Accessing outside resources and collaboration among systems is an essential element of high-quality inclusive practice (DEC, 2014). In this first national view of HBCC providers, findings suggest that some providers are accessing some outside supports, particularly in the area of developmental screenings. However, the majority of providers are not accessing or connecting families to these services. Future research should explore whether accessing outside resources for this population of caregivers is related to awareness of services or whether such resources traditionally do not provide outreach to HBCC community.

Limitations

A primary limitation of the NSECE data is that children’s disability status is reported by the HBCC provider and is based on the providers’ perception of whether the children enrolled have a disability. Information is not available within the data set regarding the nature or severity of the disability. We also do not know whether the child has been formally diagnosed with a disability or delay or the age of the child with the disability.

Because this is cross-sectional data, we do not know how providers may change their practices based on inputs like taking a course or a workshop about caring for children with disabilities. In addition, as providers have not been randomly assigned to care for children with disabilities, there are likely additional provider characteristics that influenced them to enroll a child with a disability that were not measured in the NSECE. Similarly, these differences in provider characteristics, as well as the characteristics of the children enrolled, may even influence providers’ perceptions of whether a child has a disability. Although providers are asked about referring families to outside resources, we do not know whether these referrals are specifically to services such as early intervention.

Implications and Directions for Future Research

These results highlight that many young children whom providers identify as having disabilities are cared for in home-based settings. Therefore, it is important to ensure that home-based providers have access to resources that will support them in their work. It may be that HBCC providers are not aware of resources they could be accessing to support them in their work with children with disabilities, it may be that resources are not available to them, or HBCC providers may not be interested in engaging with outside systems. More research is needed to further explore the low rate of accessing resources. This study highlights the need to seek more information from home-based providers serving children with disabilities to learn about their needs and their experiences, as the well as the need to ensure that this group can access early intervention resources that will support them in their work.

More research is needed to provide a more nuanced view of these caregivers and their experiences with professional development and community systems. Specifically, future research should examine the professional development needs of HBCC providers as well as professional development and technical assistance models to effectively engage and assist this caregiving sector. Future research should also emphasize the child care needs of families of young children with disabilities, and in particular, familial perspectives on HBCC. Likewise, study findings raise the need for broader state systems to consider how HBCC are served in various systems of care and support, including the early intervention system. This can include ensuring providers have access to relevant group and onsite professional development to support them in their work. Taken together, these findings highlight the need for more attention to support HBCC providers serving children with disabilities. This national portrait of HBCC indicates that this sector of child care reports that they are serving children with disabilities and that providers are accessing both professional development and community supports at relatively low levels.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Alison Hooper

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