Child care for low-income school-age children: Disability and family structure effects in a national sample

Children and Youth Services Review 28 (2006) 927 – 940 www.elsevier.com/locate/childyouth

Child care for low-income school-age children: Disability and family structure effects in a national sample Susan L. Parish *, Jennifer M. Cloud School of Social Work, University of North Carolina at Chapel Hill, 301 Pittsboro Street, CB 3550, Chapel Hill, NC 27599-3550, United States Received 1 August 2005; received in revised form 27 September 2005; accepted 4 October 2005 Available online 13 December 2005

Abstract A secondary analysis of data from the National Survey of America’s Families was conducted to explore the use and quality of child care of a nationally representative sample of low-income school-aged children, stratified by disability status and family structure. Measures of care included hours spent in care, hours of self-care, number of care arrangements used per week, costs of care, type of primary care arrangement, and whether parents arranged their work around care. Both family structure and children’s disability status influenced the use and quality of care, with children of single parents, and particularly disabled children, seemingly at greatest risk for adverse developmental outcomes related to the care they received. D 2005 Elsevier Ltd. All rights reserved. Keywords: After care; Child care; Children with disabilities; Family structure

1. Introduction During the past few decades, national policy and research attention has focused on how school-age children of employed parents spend their time outside of school hours. Regrettably, this increased attention has barely addressed the experiences of children with disabilities. The federal welfare law changes enacted in 1996 increased the importance of learning more about the child care of low-income disabled children. Unlike AFDC before it, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 did not exempt parents of disabled children from the mandatory work required in order to receive TANF cash assistance. * Corresponding author. Tel.: +1 919 962 6434; fax: +1 919 962 7557. E-mail address: [email protected] (S.L. Parish). 0190-7409/$ - see front matter D 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2005.10.001

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PRWORA thus heralded a major change for low-income families of children with disabilities, because the elevated care needs of children with disabilities were no longer a direct consideration in welfare policy. Under PRWORA guidelines, states have discretion to exempt up to 20% of their caseloads from work requirements or they may choose to enact work participation rules that are more stringent than the federal minimums. Seventeen states require work effort from at least some parents of disabled children, and an additional 13 states mandate universal work participation, regardless of beneficiaries’ caregiving responsibilities (Thompson, Holcomb, Loprest & Brennan, 1998). Since PRWORA increased the emphasis on employment for all low-income parents, the availability of care while children are not in school is vital in order for parents to participate in TANF’s work requirements. Researchers have examined several preconditions of employment: labor market conditions, parents’ training and readiness, and the availability of child care (e.g., Blau & Tekin, 2001; Cancian & Meyer, 2000; Olson & Pavetti, 1996). Child care is a necessary prerequisite for parental employment, but the use of child care for low-income disabled children is largely unknown. Child care for disabled children is a critical issue due to the sheer size of the population. An estimated 12% of children aged 5 to 17 years (Hogan, Msall, Rogers, & Avery, 1997) or approximately 6.6 million children in 2000 (U.S. Census Bureau, 2001) had disabling conditions. Furthermore, many families of disabled children are directly affected by TANF. Children with disabilities are over-represented in poverty: 28% of disabled children live in households with income below the federal poverty level, as compared to 16% of typically developing children (Fujiura & Yamaki, 2000). Because low-income families of children with disabilities are no longer exempted from the work requirements of welfare policy, understanding their child care use can inform policy makers and practitioners interested in facilitating these parents’ employment. This paper explores the child care use of low-income school-age disabled and nondisabled children stratified by whether they live in single- or two-parent households. Three research questions were addressed: (1) What are the types, general costs, and hours of use of child care by low-income school-age children with disabilities in the United States? (2) How does family structure influence the child care used by low-income school-age children with disabilities in the United States? (3) Do differences exist in the quality of care received by low-income children with disabilities as compared with nondisabled low-income children? 2. Background The child care of low-income disabled school children is influenced by the larger national welfare policy context. As such, these policies are described first. Lacking much direct evidence related to the child care of disabled children, the existing research on nondisabled school children’s care is reviewed, followed by the relationship between family structure and child care. Finally, the limited existing research on disabled school-age children’s child care is examined. 2.1. PRWORA, child care and low-income families An understanding of PRWORA and current child care policy is necessary in order to place research on child care use in context. Current child care policy for low-income families has been designed to complement recent welfare legislation. PRWORA both requires parents to work and limits receipt of cash benefits to a lifetime maximum of 60 months. Under the current law,

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parents are required to work 20 h/week, but increased requirements for work participation are integral to both currently pending House and Senate TANF reauthorization bills. The House bill would expand work participation to 40 h/week regardless of family size, structure, or factors such as children’s disability. The current Senate bill would increase weekly work participation requirements to 34 h. Neither bill provides further work exemptions for parents of children with disabilities (Fremstad & Parrott, 2004), so existing state policies related to children’s disabilities are unlikely to change. Elevated work requirements likely will increase the need for child care among low-income children with disabilities. PRWORA consolidated existing child subsidy programs into the Child Care Development Fund (CCDF), which is intended to provide child care assistance for low-income parents engaged in work-related activities who either receive TANF or have been diverted from TANF (Meyers, Heintze, & Wolf, 2002). Pending TANF reauthorization legislation will also affect child care. Both the House and Senate bills would increase federal funding for child care provided to the states via CCDF. The pending Senate bill would add $7 billion (Fremstad & Parrott, 2004) and HR 4 would add more than $1 billion immediately and $200 million annually for the next five years (House of Representatives, 2003). However, neither version is sufficient. The proposed House increase is inadequate to maintain current child care levels, much less address the increased demand for child care that should result from increased TANF work requirements also contained in both reauthorization bills. The Senate bill would maintain existing coverage but would not increase the number of participants (Fremstad & Parrott, 2004). Affordable child care is an important prerequisite for maintaining employment for lowincome parents and welfare-to-work programs are undermined by inadequate child care (GAO, 2003). Adequate, affordable child care is elusive for many low-income families. Despite federal funding, only 10% of eligible children across the United States benefited from subsidies in 1998 (Child Care Bureau, 1999). Many eligible parents do not receive subsidies because they are unaware of the available programs or believe they are not eligible (Blau & Tekin, 2001; Shlay, Weinraub, Harmon, & Tran, 2004). Furthermore, states report long waiting lists for child care subsidies, which likely deter applicants (Ganow, 2000; Meyers et al., 2002). In addition to cost, the availability and flexibility of child care arrangements are of great concern to low-income parents. For many low-income families, especially those participating in welfare-to-work programs, the typically inflexible work schedules common in low-paying jobs can make traditional child care, with its limited hours of operation, problematic (Ganow, 2000; Knox, London, & Scott, 2003). In addition, the financial instability that characterizes many lowincome families, with cycles into and out of employment (Iceland, 2003), means that lowincome families have dynamic needs for child care (Knox et al., 2003). These issues make it difficult for low-income families to utilize traditional child care, which generally relies on consistent, standardized schedules. Parents may find care by a relative a more accommodating alternative (Bromer & Henly, 2004; Knox et al., 2003; Lowe & Weisner, 2004), and a way to avoid the substandard care that is often the only option in low-income neighborhoods (Larner & Phillips, 1994). Nonkinship family day care centers may also be more flexible regarding schedule and payment, and thus preferable over child care centers for low-income parents (Brandon & Hofferth, 2003; Bromer & Henly, 2004). A national study found that roughly onethird of children between the ages of six through twelve from low-income families were cared for by a relative (Sonenstein, Gates, Schmidt & Bolshun, 2002). However, for low-income school-age children, participation in formal after-school programs had a greater positive impact on school grades, emotional adjustment and interpersonal skills than maternal care or care provided by other adults (Posner & Vandell, 1994). These positive effects are hypothesized to be

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related to increased opportunities and structure provided to low-income children in formal afterschool programs. For example, the children were given increased exposure to cultural activities such as music, art and dance, and received intensive homework assistance (Posner & Vandell, 1994). 2.2. Child care for the general child population Over the past several decades of shifting family demography, mothers’ employment has increased. Because mothers are typically their children’s primary caregivers, concern has grown over the effect increased maternal employment and use of child care has on children’s well-being (Brandon & Hofferth, 2003). Consensus is emerging that high quality out-of-school care promotes positive child development and academic achievement (Hall, Yohalem, Tolman, & Wilson, 2003). Yet the system of child care in the United States is often characterized as being in crisis due to its supply, cost, and quality (Blau, 2001; Zigler & Lang, 1991). In the United States, non-parental child care is widely utilized while parents are working and unable to directly supervise their children. In one national study, 46% of children between the ages of 6 and 12 were in some form of regular, supervised child care (Vandivere, Tout, Zaslow, Calkins, & Capizzano, 2003). School-age children are typically supervised during out-of-school time (including before and after school and while school is not in session) by an array of sources, including relatives, family day care homes, and center- or school-based programs. This seemingly simple categorization belies enormous diversity of caregiver age, training, and experience; caregiver–child relationships; facility size and philosophy; and ultimately, the quality of care (Zigler & Lang, 1991). There is agreement that time spent out of school has significant consequences for an array of children’s developmental outcomes (Hall et al., 2003). In addition to receiving care in a formal program, some children supervise themselves or are supervised by other children, so-called self-care (Kleiner, Nolin, & Chapman, 2004). Self-care was reported as the primary care arrangement for 19% of 10–12 year olds and 3% of 6–9 year olds (Vandivere et al., 2003). Self-care has some negative effects on child development. For younger children, the amount of time without adult supervision is related to increased antisocial behaviors (Posner & Vandell, 1994; Vandell & Shumow, 1999). There is wide variability in the prevalence of self-care, with significant differences depending on children’s age, gender, maturity, and neighborhood factors (Kerrebrock & Lewit, 1999). The risks to children of being in self-care are related to potential injuries, adverse developmental outcomes, and the potential for suffering emotional harm (Kerrebrock & Lewit, 1999). The cost of child care is among the most significant expenditures families face in raising their children — especially low-income families. In one national study, half of responding states reported average annual costs ranging from $1500 to $3000; the remainder reported average costs ranging from $3001 to almost $6000 for part-time, center-based care (Schulman, 2000). Families with children between the ages of five and fourteen who lived in poverty spent an average of 33% of their total income on child care (U.S. Census Bureau, 2003). This places enormous stress on the budgets of low-income families (Schulman, 2000). There is ongoing debate in the child care field over the extent to which higher costs ensure quality of care (Blau, 2001). Although high cost cannot be presumed to ensure high quality care, it is unlikely that care obtained at very low cost is comparable in quality to high cost care. Further research into this relationship is needed. Previous research has found upper-income families have the greatest access to child care programs. Greater financial resources enable these parents to select high quality care for their

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children while they work. Middle- and upper-income parents define quality child care in terms of nurturing providers who offer children a safe environment that is cognitively enriching (Hall et al., 2003; Hofferth, Brayfield, Deich, & Holcomb, 1991). Low-income parents share congruent desires for quality care arrangements but have difficulty obtaining them because of cost, availability, and schedule flexibility (Brandon & Hofferth, 2003; Meyers, 1993). For low-income families, having affordable, reliable, and stable child care arrangements is crucial for job retention and subsequent financial well-being (Hofferth, 1995; Meyers et al., 2002). 2.3. Family structure and child care There is a strong and direct relationship between income and family structure, and families headed by single parents have significantly lower income than two-parent families (Lichter & Eggebeen, 1994). With greater income and potentially greater work flexibility, two-parent families may have more child care choices and different patterns of child care utilization than single parents. Studies comparing the child care arrangements of school-aged children in single-parent and two-parent families have found children from single-parent homes are more likely to have nonparental before- and after-school care arrangements while children from two-parent homes are more likely to be cared for by their parents (Brandon & Hofferth, 2003; Kleiner et al., 2004). Parental care is more likely because partners in two-parent families have greater flexibility to arrange their work schedules to share child care responsibilities. Children from single-parent homes are more likely to be cared for by relatives than children from two-parent homes (Brandon & Hofferth, 2003). Finally, children from single-parent homes were more likely than other children to have self-care as an after-school care arrangement (Kleiner et al., 2004). Therefore, there is some evidence that family structure impacts child care use. Children from single-parent homes are more likely to be cared for by relatives, to have before- and after-school care arrangements and to be in self-care than children living with two parents (Brandon & Hofferth, 2003; Kleiner et al., 2004). 2.4. Child care for children with disabilities For children with disabilities, in particular, whose support and supervision needs frequently extend into adolescence and adulthood, the availability of care when they are school-aged can be vital to their parents’ ability to maintain employment. While a great deal is known about child care for nondisabled children, relatively little is known about disabled children’s use of child care (Fink, 1988; Zigler & Lang, 1991). This section describes the existing research on care for school-aged disabled children and the barriers their families face in securing such care. Zigler and Lang (1991) have identified a host of obstacles parents face in securing child care for their disabled children including inadequate numbers of trained caregivers who can effectively meet disabled children’s specialized care needs, prejudice and fear about disability, limited knowledge regarding the nature of impairments, and transportation barriers for children with mobility impairments. In small-scale studies, mothers of disabled children have reported that a lack of affordable and adequate child care limited their ability to maintain employment (Fink, 1988; Shearn & Todd, 2000). Disabled children’s child care use is complicated by limited options. The extent to which day care centers and family care homes accept children with disabilities is unclear. In one study,

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approximately 50% of parents of disabled children between 8 and 16 years of age reported being denied child care because of their child’s impairments (Fink, 1988). A number of major methodological problems plague the existing research on disabled schoolaged children’s care and limit extant knowledge. For example, in most of the research, samples were small and specific to a single site. In addition, selection biases undermine attempts to draw clear conclusions (i.e., respondents were not randomly chosen, but were selected based on the child’s receipt of other services or the parent’s willingness to participate in the study). Furthermore, these studies relied on middle- and upper-income parents, whose resources and experiences likely differ in important ways from those of low-income parents. Largely missing from the research is the child care use of low-income families with schoolage disabled children and how such care varies by family structure. While these families are among those directly affected by TANF, nothing is known about the cost, quality, amount, or type of care used in these families. Given this lack of information, it is impossible to determine appropriate policy measures. The present research was undertaken to begin to explore these issues. 3. Method 3.1. Data Source This study was conducted using data from the 1999 National Survey of America’s Families (NSAF), a national telephone and area survey of approximately 42,000 U.S. households. This cross-sectional study was conducted by the Urban Institute and Child Trends and is nationally representative of the civilian, noninstitutionalized population of children and adults under age 65 (Safir, Scheuren, & Wang, 2000). The NSAF had two components: a random-digit dialed telephone survey of households with telephones and an area sample for households without telephones (Judkins, Brick, Broene, Ferraro, & Strickler, 2000). The area sample was used to oversample low-income families to ensure full sampling frame coverage because an estimated 20% of poor families do not have telephones (Giesbrecht, Kulp, & Starer, 1996). To conduct the area sample, respondents in households without telephones were loaned cell phones for the telephone interviews. Another strength of the NSAF is that it oversampled minority populations. The NSAF collected information on an array of factors and characteristics related to health, economic, and social well-being of children and adults including children’s participation in child care. Basic demographic and socioeconomic data were also collected (Safir et al., 2000). 3.2. Sample The NSAF sub-sample for this study included children aged 6–12 years who were living in households with combined income below 200% of the federal poverty level and for whom child care and demographic data were available. Families were randomly selected for inclusion from the NSAF, and within families, a study child was randomly selected from all children living in the household. The adult living in the household who was bmost knowledgableQ about the child provided responses to all questions about the child, in most cases the mother. Children’s disability status was determined from the question, bDoes the child have a physical, learning, or mental health condition that limits his or her participation in the usual kinds of activities done by most children his/her age?Q For reports of byes,Q children were considered to have a disability; for reports of bno,Q children were considered to be nondisabled.

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The present study sample included 5045 children, including 738 disabled and 4307 nondisabled children. When weighted, they represented 3.0 million disabled and 25.6 million nondisabled children, respectively. 3.3. Measures Several measures were used to describe child care: the number of care arrangements per week, hours spent in care per week, monthly expenditures for care, whether a child was in care or not, whether a center- or school-based program was the primary care arrangement, whether a relative was the primary care provider, and whether or not the caregiver in the child’s home was kin. Finally, the extent to which work was arranged around children’s care needs was measured by the question bDuring the last month, did you and your spouse/partner work different hours so that the two of you could take care of your child while the other person worked?Q To examine quality of care, for which there is no direct measure in the NSAF data, two measures were used, including a proxy measure devised by the researchers. The first proxy measure was the hourly cost of care, which was computed by dividing monthly expenditures by the total hours of care a

Table 1 Description of sample characteristics

Child age 6–8 9–12 Total number of children in household b17 years of age* 1–2 3–4 5+ Mother’s highest degree Less than high school High school/some college College graduate Combined household income bFPL** 100–199% of the FPL** Child race/ethnicity White Black Latino Other Child gender Female Male Family structure Single-parent Two-parent

Disabled

Nondisabled

n = 738

n = 4307

n (%) 311 (42) 427 (58)

n (%) 2162 (50) 2145 (50)

406 (55) 283 (38) 49 (7)

2354 (55) 1685 (39) 268 (6)

233 (38) 349 (57) 37 (6)

1075 (29) 2231 (60) 409 (11)

330 (45) 408 (55)

1563 (36) 2744 (64)

380 182 147 29

2195 968 992 153

(52) (25) (20) (4)

(51) (23) (23) (4)

274 (37) 464 (63)

2228 (52) 2079 (48)

379 (51) 359 (49)

1909 (44) 2398 (55)

Notes *Includes respondent children. **Federal poverty level (FPL), calculated based on number of individuals living in household and combined income from all sources (U.S. DHHS, 2004).

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child received per month. The second measure of quality was the number of hours children spent caring for themselves per week. 3.4. Analyses Because the analyses are of a stratified sample, SUDAAN was used to correct standard errors and allow for the calculation of correct inferential statistics (see Table 1). SUDAAN uses Taylorseries linearization to appropriately estimate variance with survey data derived from complex sampling designs (Research Triangle Institute, 2001) such as the NSAF (Safir et al., 2000). Analysis of covariance (ANCOVA) and multivariate logistic regression were the primary analytic strategies. For the ANCOVA results, parameter estimates are presented, adjusted for the covariates in the models, and Wald F scores are presented for the disability and family structure groupings, with all covariates in the model. The p-values of statistically significant group contrasts are also presented (Table 2). ANCOVA was used for continuous dependent measures (e.g., hours of care per week), and Bonferroni-adjusted post hoc comparisons were conducted if group differences were found for the overall model. Comparisons of children stratified by disability status and family structure were analyzed as follows: (1) disabled children in singleparent homes; (2) disabled children in two-parent homes; (3) nondisabled children in singleparent homes; and (4) nondisabled children in two-parent homes.

Table 2 Child care of low-income school-age children by disability status and family structure, adjusted for child age, maternal education and number of children (b17 years of age) living in household Outcome measure

Disabled child with single parent

Disabled child with two parents

Nondisabled child with single parent

Nondisabled child with two parents

n = 379

n = 359

n = 1909

n = 2398

Mean Number of care arrangements per week Hours in care per week Monthly expenditure for care Hourly cost of care Hours child care for self per week

0.6

a,b,c

Wald F a,d

b,d,e

c,e

0.4

0.8

0.4

21.0***

8.2a,b $196

5.4a,c $231

11.0c,d $219

3.6b,d $164

34.9*** 2.4

$3.63a,b 5.0a

$4.79 3.4b

$4.83a 6.1b,c

$6.45b 3.2a,c

2.4y 4.9**

c,d

b,d

Predicted probabilities In some form of child care (% yes) Work is arranged around care (% yes) Center is primary form of care (% yes) Relative is primary form of care (% yes) Caregiver in home is kin (% yes) y

Test statistic

a,b

Wald F a,c

59%

45%

68%

41%

48%

72%

2%

74%

0.4

11.8%a

5%

10%b

4.5%a,b

9.4***

25%a

27%

36%a,b

21%b

7.8***

65%a,b

92%a

82%

85%b

2.9*

21.7***

p b 0.10; *p b 0.05; **p b 0.01; ***p b 0.001. Statistically significant and trend-level group differences are indicated by alphabetic superscripts for each measure.

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Logistic regression models were estimated for binary dependent measures (e.g., in child care, work is arranged around care). For ease of interpreting the logistic regression estimates, results are reported as predicted probabilities for each group of children. Predicted probabilities show the likelihood of event occurrence for children with different disability states and family structures, and therefore range from 0 to 1. These probabilities were obtained by solving the logit equation for the probability of attending child care, for example, for any given combination of disability status and family structure variables, holding all other covariates at their sample means. All models controlled for age of the child, maternal education, and the number of children living in the household who were under age 17. These factors have been found to be associated with maternal employment and use of child care (Blau & Robins, 1991; Waldfogel, 1997). Data and the results presented here are weighted to reflect undercoverage and nonresponse, each respondent’s probability of selection, as well as the age, sex, and ethnic or racial distribution of the U.S. Census estimates for the respondent. The present study’s results can be generalized to the noninstitutionalized population of children with and without disabilities between ages six and twelve living in the United States in 1999. 4. Results The sample’s demographic characteristics are provided by the descriptive statistics in Table 1. Significant differences were not found between the groups of children in terms of their race or the number of children under age 17 who were living in the household. Disabled children were slightly older (mean = 9.0 years) than the cohort of nondisabled children (mean = 8.7 years; F = 13.9, p b 0.001). Mothers of children with disabilities were less educated, on average, than mothers of nondisabled children in this sample (X 2 = 27.6, 2 df; p b 0.001). Within this lowincome sample, disabled children were poorer than nondisabled children: 45% of the disabled sample had family earnings below the federal poverty line, higher than the 36% of nondisabled children (X 2 = 19.1, 1 df; p b 0.001). Gender differences were also found in the sample: 37% of the disabled children were girls, as contrasted with 52% of the nondisabled children (X 2 = 53.7, 1 df, p b 0.001). Finally, statistically significant differences were found in the family structure of the sample groups. Fifty-one percent of disabled children lived with a single parent as compared to 44% of nondisabled children (X 2 = 12.6, 1 df, p b 0.001). Table 2 presents the findings related to the three research questions, and all models control for child age, mother’s education and number of children living in the household (covariate data not shown). For the first and second research questions, the general use of child care for school-age children in low-income families and whether those differed by family structure and disability status was described. Children living with single parents were more likely to be in care than children living with two parents. Statistically significant differences were not found between disabled (59%) and nondisabled (68%) children living with single parents in the likelihood of being in care at all. But children living with two parents were less likely to be in care than children living with one parent ( F = 21.7, p b 0.001). Mean use of child care was 45% for disabled and 41% of nondisabled children living with two parents. However, disability-related differences were found in the number of care arrangements used by children per week. Disabled children living with single parents had fewer care arrangements (0.6) than nondisabled children living with a single parent (0.8), and more arrangements than disabled and nondisabled children living with two parents (0.4 for both)

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( F = 21.0, p b 0.01). The number of hours children spent in care each week was more related to living with a single parent than to disability status. Disabled and nondisabled children living with a single parent spent 8.2 and 11.0 h in care per week, significantly more than the 5.4 and 3.6 h of disabled and nondisabled children, respectively, living with two parents ( F = 34.9, p b 0.01). Disabled and nondisabled children living with single parents differed in terms of the primary type of care that they used. Disabled children living with a single parent were less likely to have a relative (25%) provide primary care than nondisabled children living with one parent (36%) and more likely than nondisabled children living with two parents (21%) ( F = 7.8, p b 0.001). Disabled and nondisabled children living with a single parent were more likely to have a centeror school-based care as their primary arrangement than nondisabled children living with two parents (4.5%, F = 9.4, p b 0.001). For children who received (non-parental) care in their own homes, disabled children living with single parents were significantly less likely to be cared for by a relative (65%) than all other groups of children, who had relatives care for them in their own homes at rates ranging from 82% to 92% ( F = 2.9, p b 0.05). Statistically significant differences were not found in the average monthly expenditure for child care, or the likelihood that parents arranged their work schedule around child care. In terms of the quality of care received, trend level differences were found in the hourly cost of care between groups of children. Single parents of disabled children paid $3.63/h, well below the mean cost for single parents of nondisabled children ($4.83) and two-parent families of nondisabled children ($6.45) ( F = 2.4, p b 0.10). The hours children spent each week in self-care was the second indicator of quality. Disabled children of single parents spent 5.0 h/week caring for themselves, significantly above the 3.2 h nondisabled children of two parents spent in self-care. Nondisabled children living with single parents also spent more hours per week caring for themselves (6.1) as contrasted with disabled (3.4) and nondisabled (3.2) children living with two parents ( F = 4.9, p b 0.01). 5. Discussion This study was developed to begin to illuminate the child care used by low-income schoolage children with disabilities, whose families are directly affected by welfare policies. To the best of our knowledge, it represents the first nationally representative probability sample study of child care for low-income school-age disabled children. However, several limitations warrant consideration to fairly interpret the results. First, the relationship between parental employment and use of child care for disabled and nondisabled children could not be directly measured because the children in the NSAF sample were randomly selected. Some of the nondisabled children would have had disabled siblings whose impairments influenced their parents’ employment and thereby would have biased employment estimates. Second, due to the small sample size of disabled children, it was not possible to examine how child care varies by race or ethnicity. This issue is likely significant, as Neely-Barnes and Marcenko (2004) found that race predicted the financial impact disabled children have on their families. Given this potential impact on family resources, the child care arrangements for minority children with disabilities could differ from what is presented here. Finally, the magnitude of the impact on families of having children with disabilities depends partly on the severity of children’s disabilities (e.g., Lukemeyer, Meyers, & Smeeding, 2000). Since the NSAF did not collect information on the severity of children’s impairments, it was not

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possible to analyze its influence; nuances regarding the relationship between impairment severity and child care could not be captured in this analysis. In terms of overall use of child care, family structure and disability status were both important to understanding child care for school-aged children. On some measures, like the likelihood of using care at all, family structure was a more important predictor than children’s disability status. On other measures, like the hourly cost of care, disability status was an important predictor. These findings are at odds with previously reported research in which mothers reported being largely unable to find child care for their disabled children (e.g., Shearn & Todd, 2000). Previous research has generally used nonprobability samples and has recruited participants from middleclass families. However, it is important to note that this probability sample consisted exclusively of low-income children (those living in households with income below 200% of the federal poverty level). The contrast between the present findings and those of previous research that exclusively examined middle- and upper-income samples of families with disabled children is important. In the present study, children’s disability status was related to the use and quality of care for school-aged children, but disability status did not translate into colossal differences in care, except perhaps on the quality of care measure, hourly cost. In previous research, middleand upper-income mothers reported that they were unable to find suitable care for their disabled children. Yet the present study’s results suggest that for low-income mothers, and particularly for single parents, not finding suitable child care for a disabled child is simply not an option. Further, although child care quality could not be measured directly with these data, two approximate measures of quality require further elaboration. In terms of self-care, disabled and nondisabled children with single parents spent more time without supervision than disabled and nondisabled children living with two parents. Lower amounts of time spent without supervision are better for children. It is not generally advisable for children under age 11 to be left alone and children between 11 and 13 should not be left alone for extended periods of time (Zigler & Lang, 1991). However, for disabled children, whose impairments necessitate greater levels of support and supervision, even as they age, time without supervision likely poses a greater risk to their well-being than it does to the welfare of similarly aged nondisabled children. The finding regarding the singularly low hourly costs of care for disabled children in singleparent homes, as contrasted with all nondisabled children, is troubling. It suggests the care these disabled children receive may be of questionable quality. While previous research neither supports nor refutes the direct presumption that high quality is achieved by paying high costs for care, it is logically unlikely that similar quality of care is being received at such substantially lower hourly costs. Whereas the number of care arrangements did not differ for disabled and nondisabled children in single-parent homes, the number of care arrangements was higher for these children than for children in two-parent homes. This finding is meaningful because having more care arrangements translates into encountering more individual caregivers. The single parents of disabled children endure added stress and obstacles in managing multiple care arrangements, a situation complicated by their child’s impairments, which necessitate more specialized care (Perrin, 2002). Disabled children’s impairments make them fragile and more vulnerable to inadequate care (Zigler & Lang, 1991), and the coordination of care across several providers increases the risk of adverse developmental outcomes.

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These findings represent an important first step in understanding the use of child care for lowincome disabled children: they suggest low-income school-aged children with disabilities who live with a single parent may be at greater risk for adverse outcomes than other children. These results also point to the importance of examining the family structure context in which disabled children live. Aggregating these children only into disabled and nondisabled groups would have masked some of the important group differences that were found. 6. Conclusion For all children, living in poverty is associated with increased risk for a host of adverse consequences, including poor physical health, diminished cognitive abilities, behavioral problems, and reduced educational attainment (Brooks-Gunn & Duncan, 1997). Poverty may have even more deleterious effects for disabled children than it does for typically developing children because disabled children require greater levels of care and stimulation to achieve proper growth, prevent regression and loss of skills, and avert the development of secondary conditions (Park, Turnbull, & Turnbull, 2002; Perrin, 2002). To be effective, child care policies must respond to the unique issues of low-income disabled children. In recognition of the fact that child care is a prerequisite for parental employment, expanding the availability of child care has become an important mechanism for the national priority of increasing low-income parents’ employment. Low-income parents of disabled children are not exempted from TANF’s mandatory work requirements. However, the present findings suggest the care received by disabled children of low-income single parents may be of lower-quality than that received by other low-income children. Disabled children from low-income families, whose impairments require skilled care beyond the needs of typically developing children (Perrin, 2002), seem to be particularly at risk for adverse outcomes associated with inadequate child care. If cost is a barrier to receipt of high quality care for disabled children living with a single parent, as seems likely from these results, expanding existing child care subsidies for low-income disabled children is warranted. Moreover, these exploratory findings clarify the need for further research to fully understand the specific barriers to high quality child care that low-income families of disabled children face. Acknowledgements We are indebted to Dr. Shenyang Guo, School of Social Work, University of North Carolina at Chapel Hill for his assistance with some of the statistical procedures. We also appreciate the support provided by Adam Safir at the Urban Institute in using the National Survey of America’s Families. Funding for this research was provided in part by a Junior Faculty Development Award to the first author by the University of North Carolina at Chapel Hill. References Blau, D. M. (2001). The child care problem: An economic analysis. New York7 Russell Sage. Blau, D. M., & Robins, P. K. (1991). Child care demand and labor supply of young mothers over time. Demography, 28, 333 – 351. Blau, D. & Tekin, E. (2001). The determinants and consequences of child care subsidies for single mother: Discussion paper 383. Bonn, Germany: Institute for the Study of Labor. Brandon, P. D., & Hofferth, S. L. (2003). Determinants of out-of-school childcare arrangements among children in singlemother and two-parent families. Social Science Research, 32, 129 – 147.

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