- Email: [email protected]
Child care, disability, and family structure: Use and quality in a population-based sample of low-income preschool children
Children and Youth Services Review 27 (2005) 905 – 919 www.elsevier.com/locate/childyouth
Child care, disability, and family structure: Use and quality in a population-based sample of low-income preschool children Susan L. Parisha,*, Jennifer M. Clouda, Jungwon Huha, Ashley N. Henningb a
School of Social Work, University of North Carolina at Chapel Hill 301 Pittsboro Street, CB 3550 Chapel Hill, NC 27599-3550, United States b School of Social Work University of Wisconsin—Whitewater, United States Received 17 October 2004; received in revised form 1 December 2004; accepted 2 December 2004
Abstract The National Survey of America’s Families (NSAF) was analyzed to examine the use and quality of child care of low-income preschool children with disabilities as contrasted to low-income nondisabled children. Family structure is a stronger predictor of child care use than disability status. Disabled and nondisabled children living with single parents show similarly elevated rates of participation in child care. Important differences were found in the use and quality of child care. Our findings related to the extremely low cost of care for disabled children living with single parents may suggest particularly deleterious developmental outcomes for these children. These findings suggest the need for child care subsidies directed at low-income disabled children and their families. Further, the protective enforcement of minimum standards of care may require further analysis. D 2004 Elsevier Ltd. All rights reserved. Keywords: Child care; Children with disabilities; Family structure; Welfare
* 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 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2004.12.007
906
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
1. Introduction The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 failed to excuse parents of disabled children from the mandatory work required in order to receive benefits. In contrast, the AFDC program had recognized the elevated care needs of children with disabilities and included provisions exempting their parents from work requirements. Thus, PRWORA heralded a major change for low-income families of children with disabilities. Under PRWORA guidelines, states have discretion to exempt 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). All states are prohibited from terminating cash payments to single parents who are unable to find child care for a child under age six, and states have the discretion to exempt other parents. Fourteen states offer this so-called child care protection to parents of children with disabilities (State Policy Documentation Project, 2000). States also may exempt parents whose responsibilities to provide care for a disabled household member prevent them from working, and 22 states employ at least part of this exemption (State Policy Documentation Project, 2000). Since PRWORA increases the emphasis on employment of all low-income parents, the availability of child care, along with other factors affecting employment, is vital in order to participate in TANF. Researchers have examined the following prerequisites of employment: labor market conditions, parents’ training and readiness, and availability of child care (e.g., Blau & Tekin, 2001; Cancian & Meyer, 2000; Olson & Pavetti, 1996). Child care is a necessary precondition of parental employment, but the use of child care for lowincome disabled children is unknown. Child care for disabled children is a critical issue due to the sheer number of disabled children. An estimated 12% of children aged 5–17 years (Hogan, Msall, Rogers, & Avery, 1997) or approximately 6.6 million children in 2000 (U.S. Census Bureau, 2001) have a disabling condition. Furthermore, children with disabilities are significantly more likely to live in impoverished households: 28% of disabled children live in households with income below the federal poverty level (FPL), 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 is vital to policy makers and practitioners interested in facilitating the employment of these parents. This paper explores the child care use of low-income children with disabilities and for children stratified by whether they live in single- or two-parent households. The three research questions are: (1) What are the types, general costs, and hours of use of child care by low-income preschool children with disabilities in the United States? (2) How does family structure influence the child care used by low-income 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?
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
907
2. Background 2.1. Child care for the general child population Disabled and nondisabled children have similar needs regarding availability of child care, and thus an examination of the literature on child care for the general population is informative. In the United States, nonparental child care is widely utilized by working parents. The vast majority (about 75%) of children under five years of age were in some form of regular child care in 1995 (Smith, 2000). Child care is generally provided in three settings: the child’s home, a family day care home (kinship or nonkinship home), or a day care center (Zigler & Lang, 1991). This seemingly simple categorization belies enormous diversity of caregiver age, training, and experience; caregiver–child relationships; facility size and licensure; and ultimately, the quality of care (Zigler & Lang, 1991). Due to the extensive amount of time children spend in child care, it is, arguably, one of the four primary social systems, along with families, schooling, and health care, which interact to determine children’s development (Zigler & Gilman, 1996). The increase in mothers’ employment during the last decades is evident from the majority of young children who are in some form of regular child care (Kamerman, 1995). Because mothers are typically the primary caregivers for their children, concern has grown over the effect of increased mothers’ employment and use of child care arrangements on children’s well-being (Brandon & Hoffert, 2003). Quality of care is associated with both improved cognitive and social development, and existing research indicates high quality care promotes better outcomes in these domains (Child Care Bureau, 1999; Loeb et al., 2003). However, the United States system of child care is frequently characterized as being in a state of crisis due to concerns about the supply, cost, and quality of care (Blau, 2001; Zigler & Lang, 1991). Yet, the extent to which these issues affect low-income children with disabilities is unclear. The cost of child care is among the most significant expenditures that families face in raising their children—especially for low-income families. Across the United States, costs for center-based child care range between the averages of US$4000–6000 for a four-year old and can exceed US$10,000 annually (Schulman, 2000). Whereas, non-poor families spend an average of 7% of their income on child care (Smith, 2000), families living below the federal poverty level spend an average of 35% of their total income on child care (Smith, 2000). 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 cost ensures quality of care (Blau, 2001). We argue that although high cost cannot assure high quality, it is logical to believe that care obtained at substantially lower cost is unlikely to be of high quality and employing this factor as a proxy for quality is a sound exploratory strategy. Past research has found upper-income families to have the greatest access to child care programs. Their financial resources enable these parents to select high quality care for their children while they work. Middle- and upper-income parents define quality child care in terms of nurturing and experienced providers who provide their children with a safe environment that is cognitively enriching (Larner & Phillips, 1994). Low-income parents share the same desires for and definitions of quality care for their children but have difficulty
908
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
obtaining high-quality child care arrangements because of issues of cost, availability, and schedule flexibility (Brandon & Hoffert, 2003; Larner & Phillips, 1994). For low-income families, having affordable, reliable, and stable child care arrangements is crucial for job retention and financial well-being (Hofferth, 1995; Meyers, Heintze, & Wolf, 2002). 2.2. Child care for children with disabilities While a great deal is known about child care for nondisabled children, relatively little is known about disabled children’s use of child care (Buysse, Wesley, Bryant, & Gardner, 1999; Zigler & Lang, 1991). We describe in this section the existing research including use and quality of care, and the barriers families face in securing care for their children with disabilities. 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, just 34% of centers in a representative, statewide sample enrolled one or more children with disabilities (Buysse et al., 1999). In another state, nearly one-third of parents reported having been denied child care due to their child’s disability, and 23% of parents who lacked child care reported they were still seeking it for their disabled child (Cutler & Gilkerson, 2002). The only nationally representative study of child care use by mothers of children with disabilities found the severity of a child’s impairments, and whether or not the child had behavioral or emotional problems predicted hours of child care use (Brandon, 2000). However, this study also had important limitations. It did not examine low-income families’ cost or quality of care, or number of care arrangements. In addition, this study used data from 1986–88 and the impacts of critical changes related to PRWORA were not measured. Zigler and Lang (1991) have identified a host of barriers parents face in securing child care for their disabled children including inadequate numbers of trained caregivers who can effectively meet disabled children’s needs, prejudice and fear about disability, limited knowledge regarding the nature of disabilities, 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 (Cuskelly, Pulman, & Hayes, 1998; Shearn & Todd, 2000). A number of major methodological problems plague the existing research on disabled children’s care and limit our knowledge. For example, in most of the research, samples were small and specific to a single site. In addition, selection biases undermine our ability 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). Most importantly, these studies relied on middle- and upper-income parents, whose resources, expectations, and experiences likely differ in important ways from those of lowincome parents. 2.3. 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 into the proper context. Current child care policy for low-
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
909
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, parents of preschoolers are required to work 20 hours a week, but increased requirements for work participation are integral to both the current House and Senate TANF reauthorization bills. The House bill would expand work participation to 40 hours per 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 hours, or to 24 hours for single mothers of preschoolers. Neither bill provides further work exemptions for parents of children with disabilities, so existing state policies are unlikely to change (Fremstad & Parrott, 2004). Elevated work requirements will likely 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 (Han & Waldfogel, 2001; Meyers et al., 2002). Pending TANF reauthorization legislation will also affect CCDF. Both the House and Senate bills increase federal funding for child care provided to the states via CCDF. The proposed Senate bill would add US$7 billion and HR 4 would add more than US$1 million immediately and US$200 million annually for the next five years (Fremstad & Parrott, 2004). However, neither version is entirely sufficient. The proposed House increase is inadequate to maintain current child care levels, much less address the increased demand for child care that will result from increased TANF work requirements. The pending Senate bill would maintain existing coverage but would not increase the number of child care 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 (General Accounting Office, 2003). However, adequate and 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, with its limited hours of operation, can make traditional child care problematic (Ganow, 2000; Knox, London, & Scott, 2003). In addition, the financial instability that characterizes many low-income families, with cycles into and out of employment (Iceland, 2003), means that low-income 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 centers, which often rely 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 &
910
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
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 (Bromer & Henly, 2004). Ehrle, Adams and Tout (2001) found that roughly half of children under the age of three from low-income families were cared for by a relative, most often a grandparent. In addition, approximately one-third of these children were in care provided by another family (Ehrle et al., 2001). However, it is important to note that one study of child care in low-income communities showed participation in center-based care led to better school readiness and improved cognitive outcomes than either kinship care or family care homes (Loeb et al., 2003). 2.4. Family structure Families headed by a single parent have significantly lower income than those headed by two parents (Lichter & Eggebeen, 1994), fewer child care choices, and different patterns of child care utilization (Brandon & Hoffert, 2003; Ehrle et al., 2001). Studies comparing the child care arrangements of infants, toddlers, and school-aged children in single- and twoparent families have found that children from single-parent homes are more likely to be cared for by relatives, while children from two-parent homes are more likely to be cared for by their parents (Brandon & Hoffert, 2003; Ehrle et al., 2001). Parental care is more likely because partners in two-parent families have greater flexibility to arrange their work schedules to share child care responsibilities. Ehrle et al. (2001) also found children from single-parents homes were in child care for more hours per week than children from twoparent homes (Ehrle et al., 2001). Therefore, there is some evidence that family structure has impact on child care use: children from single-parent homes are more likely to be cared for by relatives and to be in full-time child care than children living with two parents. Completely missing from the research is the child care use of low-income families with disabled children and how such care varies by family structure. While these families are among those directly affected by TANF, we know nothing about the cost, quality, amount of use, or type of care in these families. Given this lack of information, it is impossible to determine appropriate policy measures. The present research was undertaken 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
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
911
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 NASF sub-sample for this study included families with preschool children under the age of six 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 knowledgeableQ about the child, in most cases the mother, provided responses to all questions about the child. 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 byesQ, children were considered to have a disability; for reports of bnoQ, children were considered to be nondisabled. The present study sample included 5065 children, including 321 disabled and 4744 nondisabled children. When weighted, they represented 228,000 disabled and 2.5 million nondisabled children. 3.3. Measures Several measures of child care use, cost, and quality were used to describe whether a child was in care, the number of different care arrangements a child used each week, the number of hours a child spent in care per week, expenditures for child care the previous month, and whether a child’s primary care arrangement was a center, family care or care provided by a relative. To examine quality of care, for which there is no direct measure, two proxy measures were created. For children in center-based care, the number of children per adult caregiver was calculated. This ratio is part of the standards used to evaluate quality by state licensing agencies and the National Association for the Education of Young Children (NAEYC) which accredits child care programs nationally (Blau, 2001; Commission on NAEYC Early Childhood Program Standards, 2004). Hourly costs of care were computed by dividing monthly expenditures by the total hours of care a child received per month. 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 Taylor-series linearization to appropriately estimate variance with survey data derived from complex sampling designs (Research Triangle Institute, 2001) such as the NSAF
912
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
Table 1 Description of sample characteristics Child age 0–3 4–5
Disabled n=321 (%)
Nondisabled n=4744 (%)
162 (50.5) 159 (49.5)
2983 (62.9) 1761 (37.1)
Total number of children in household b17 years of age* 1–2 161 (50.2) 3–4 132 (41.1) 5+ 28 (8.7)
2723 (57.4) 1689 (35.8) 323 (6.8)
Mother’s highest degree lower than high school high school/some college college graduate
99 (34.3) 171 (59.2) 19 (6.6)
1366 (30.6) 2641 (59.1) 459 (10.3)
Combined household income bFPL** 100–199% of the FPL**
146 (45.5) 175 (54.5)
1815 (38.3) 2929 (61.7)
Child race/ethnicity White Black Latino Others
144 84 78 15
2243 1049 1304 148
Child gender Female Male
121 (37.7) 200 (62.3)
2397 (50.5) 2347 (49.5)
Family structure Single-parent Two-parent
149 (46.4) 172 (53.6)
1899 (40.1) 2841 (59.9)
(44.9) (26.2) (24.3) (4.7)
(47.3) (22.1) (27.5) (3.1)
* Includes respondent children. ** Federal poverty level (FPL), calculated based on numbers of individuals living in household and combined income from all sources (U.S. DHHS, 2004).
(Safir et al., 2000). Analysis of covariance (ANCOVA) and multivariate logistic regression were the primary analytic strategies. For the ANCOVA results, we present parameter estimates, adjusted for the covariates in the models, and present Wald F-scores for each overall 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 single-parent homes; (2) disabled children in two-parent homes; (3) nondisabled children in singleparent homes; and (4) nondisabled children in two-parent homes. Logistic regression models were estimated for binary dependent measures (e.g., in child care) and predicted probabilities were calculated from these. For ease of interpreting the
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
913
Table 2 Child care of low-income children by disability status and family structure, adjusted for child age, maternal education level and number of children living in household Outcome measure
Disabled child with single-parent n=149
Number of care arrangements Hours in care per week Number of children in center Monthly expenditure for care Hourly cost of care Children per adult in center
1.20a 40.1a,b 11.2 US$179a US$1.24a,b 5.4a
In some form of child care Center is primary form of care Relative is primary form of care
78%a 29%a 35%
Disabled child with two-parents n=172
Nondisabled child with single-parent n=1899
Nondisabled child with two-parents n=2841
0.75b 23.9 13.8 US$271 US$2.20 4.6a
1.16b 33.2a 12.8 US$250a US$2.60a 6.0
0.74a 22.5b 12.9 US$225 US$2.51b 6.2
79%b 28% 31%
54%a 15%a,b 22%
Mean
Test statistic
Wald F
Predicted probabilities 59%b 29%b 19%
21.7** 21.9** 1.0 1.9* 8.1* 2.0* Wald F 23.5** 11.9*** 4.0
Statistically significant and trend-level group differences are indicated by alphabetic superscripts for each measure. * pb0.05. ** pb0.01. *** pb0.001.
logistic regression estimates, we report our results 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. These probabilities were obtained by solving the logit equation for the probability of being in 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. All of 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 under age six living in the United States in 1999.
4. Results The sample’s demographic characteristics are provided by the descriptive statistics in Table 1. Within this low-income sample, disabled children were poorer than nondisabled children: 45.5% of the disabled sample had family earnings below the federal poverty line
914
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
while 38.3% of the nondisabled children had family earnings below the federal poverty level (X 2=6.61; pb0.01). 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 (data not shown). The likelihood of a child being in care at all is more strongly related to family structure than to disability status. Similar rates of child care participation were found for children living with single parents regardless of the child’s disability status (78% of disabled children and 79% of nondisabled children in single-parent homes were in some form of child care). Rates of child care participation were also closely aligned for the children, disabled or nondisabled, living with two parents (59% and 54%, respectively). However, nondisabled children living with two parents were much less likely to use a center as a primary form of care than disabled children were (15% and 19%, respectively, F=11.9, pb0.001). Statistically significant group differences were not found in the likelihood that the primary form of care was provided by a relative. Disabled and nondisabled children who lived with single parents had significantly more care arrangements than children who lived with two parents. Disabled children living in single-parent homes spent significantly more hours (40 hours per week) in care than either group of children living in two-parent homes, who had means of 23–24 hours in care per week. Analyses related to center-based care excluded children who did not attend centers. For children attending center-based care, differences were not found in the size of the centers, as measured by the total number of children participating in care. Trend-level differences were found in the monthly cost of care borne by single-parent families. Single parents of disabled and nondisabled children paid US$179 and US$250 monthly, respectively, for child care. There were also trend-level differences found regarding the amount two-parent families paid for child care in the previous month: families of disabled children paid an average of US$271 compared to care costs of US$225 for nondisabled children. Statistically significant differences were not found among the other groups. Two measures were employed related to the quality of care received, hourly cost of care and caregiver ratios. Trend-level differences were found in the hourly cost of care paid by single parents of disabled children. Single parents of disabled children paid a mean of US$1.24 per hour, while single parents of nondisabled children paid a mean of US$2.60 per hour ( F=8.1, pb0.05). The ratio of adult caregivers to children in center-based care provides a second quality indicator. Differences in the caregiver ratios were not found for children living in singleparent homes, but trend-level differences ( F=2.0, pb0.05) were found between the children living in two-parent homes. Disabled children living with two parents had a mean of 4.6 children per adult caregiver, as compared with 6.2 children per adult for the nondisabled children living with two parents.
5. Discussion This study was developed to begin to illuminate the child care used by low-income preschool children with disabilities. It constitutes the first nationally representative
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
915
investigation of child care for low-income children with disabilities. However, a number of inherent limitations warrant consideration to fairly interpret our results. First, the relationship between parental employment and use of child care for disabled and nondisabled children cannot be directly measured because the sample of children drawn from the NSAF data was randomly selected. It is possible that the nondisabled children considered in our sample might have had disabled siblings, whose impairments influenced their parents’ employment, and thereby would have caused biased employment estimates. Second, due to the small sample size of disabled children, we were unable to examine how the use of child care varies by racial or ethnic group. This is significant as found by NeelyBarnes and Marcenko (2004) who present compelling evidence that race was an important predictor of the impact, particularly financial, that disabled children have on their families. Given this potential impact on family resources, the child care arrangements for minority children with disabilities could be different than what is presented here. Finally, the magnitude of impact on families of having children with disabilities depends partly on the severity of the children’s disabilities (e.g., Lukemeyer, Meyers, & Smeeding, 2000). Since the NSAF did not collect information on disability severity, we were unable to analyze its influence and we may have missed nuances in child care related to the severity of children’s impairments. However, children with milder impairments are less likely to be represented in this sample because mild impairments (e.g., learning disabilities, ADHD) typically are not diagnosed until children enter school (Batshaw, 2002) and our sample consisted of preschool children. In terms of overall use of child care, we found differences between low-income preschoolers with and without disabilities, but family structure is also critically important. On some measures, like general use of care, family structure is a more important predictor of child care than children’s disability status. These findings are at odds with previously reported research in which mothers reported being unable to find child care for their disabled children (e.g., Cuskelly et al., 1998; Shearn & Todd, 2000). Previous research has typically used nonprobability samples and has recruited participants from middle-class families. However, it is important to note that our probability sample consisted exclusively of low-income children (those living in households with income below 200% of the federal poverty level). Although no differences were found in the size of the centers low-income disabled and nondisabled children attended, there were other notable differences among the groups. Disabled children living in single-parent homes were in care for considerably more hours each week than their nondisabled counterparts, and the amount spent per month on their care was substantially lower than the amount expended for other children. Although child care quality cannot be measured directly with these data, we can speculate about the importance of some of these measures for the quality of child care disabled children receive. In terms of the number of children per caregiver, there was a trend-level likelihood that disabled children living with two parents had fewer children per adult caregiver, as compared with 6.2 children per adult for the nondisabled children living with two parents. For this measure, fewer children per adult caregiver typically represent better quality care (Commission on NAEYC Early Childhood Program Standards, 2004). Our finding regarding the singularly low hourly costs of care for disabled children in single-parent homes suggests the care these children receive may be of questionable
916
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
quality. We argue it is highly unlikely that similar quality care is being received at such disparate 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. Doubtless these single parents endure added stress and obstacles in managing multiple care arrangements, a situation complicated by their child’s impairments and one which usually necessitates more specialized care (Perrin, 2002). Coordinating care across numerous providers increases the risk of adverse developmental outcomes for disabled children whose impairments make them fragile and more vulnerable to inadequate care. Our findings represent an important first step in understanding the use of child care for low-income disabled children: they suggest low-income children with disabilities who live with a single parent may be at greater risk for adverse outcomes than other children. Our results also point to the importance of examining the family structure context in which children live. Aggregating these children only into disabled and nondisabled groups would have masked some of the important group differences we 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, emotional and behavioral problems, and reduced educational attainment (Brooks-Gunn & Duncan, 1997). Poverty may have even more deleterious effects for disabled children than 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). To be effective, public income support and child care policies must respond to the unique issues of disabled children. In response to the recognition of child care as a prerequisite for maintaining employment, expanding the availability of child care has become an important conduit for the national priority of increasing the employment of low-income parents. Low-income parents of disabled children are not exempted from TANF’s mandatory work requirements. However, our findings indicate children with disabilities of low-income single parents are spending substantially more time in child care than other children and their care is likely 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, our results support expanding existing child care subsidies for low-income disabled children. Our results also suggest that policies should be put in place to ensure minimum care standards for disabled children. Moreover, these exploratory findings clarify the need
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
917
for further research to fully understand the child care needs and barriers facing low-income children with disabilities and their families. 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 assistance 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 Batshaw, M. L. (2002). Children with disabilities. (5th ed.). Baltimore7 Brookes. 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, Germany7 Institute for the Study of Labor. Brandon, P. D. (2000). Child care utilization among working mothers raising children with disabilities. Journal of Family and Economic Issues, 21, 343 – 364. Brandon, P. D., & Hofferth, S. L. (2003). Determinants of out-of-school childcare arrangements among children in single-mother and two-parent families. Social Science Research, 32, 129 – 147. Bromer, J., & Henly, J. R. (2004). Child care as family support: Caregiving practices across child care providers. Children and Youth Services Review, 26, 941 – 964. Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. The Future of Children, 7(2), 55 – 71. Buysse, V., Wesley, P. W., Bryant, D., & Gardner, D. (1999). Quality of early childhood programs in inclusive and noninclusive settings. Exceptional Children, 65, 301 – 314. Cancian, M., & Meyer, D. R. (2000). Work after welfare: Work effort, occupational and economic well-being. Social Work Research, 24, 69 – 86. Child Care Bureau. (1999). Access to child care for low-income working families. Washington, DC7 Author (Available at: http://www.acf.dhhs.gov/ programs/ccb/ research/ccreport/ccreport.htm). Commission on NAEYC Early Childhood Program Standards. (2004). Final draft: Early childhood program standards and accreditation performance criteria. Washington, DC7 Author. Cuskelly, M., Pulman, L., & Hayes, A. (1998). Parenting and employment decisions of parents with a preschool child with a disability. Journal of Intellectual and Developmental Disability, 23, 319 – 333. Cutler, A., & Gilkerson, L. (2002). Unmet needs project: A research, coalition building, and policy initiative on the unmet needs of infants, toddlers, and families. Chicago, IL7 University of Illinois at Chicago, Department of Disability on Human Development. Ehrle, J., Adams, G., & Tout, K. (2001). Who’s caring for our youngest children? Child care patterns of infants and toddlers. Occasional Paper, vol. 42. Washington, DC7 Urban Institute. Fremstad, S., & Parrott, S. (2004). The Senate Finance Committee’s TANF reauthorization bill. Washington, DC7 Center on Budget and Policy Priorities. Fujiura, G. T., & Yamaki, K. (2000). Trends in demography of childhood poverty and disability. Exceptional Children, 66, 187 – 199. Ganow, M. (2000). Child care subsidies: Strategies to provide outreach to eligible families. Welfare Information Network Issue Notes, 4 (Retrieved June 25, 2004 from http://www.welfareinfo.org/childcaresubsidiesissuenote.htm).
918
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
General Accounting Office. (2003, May). Child care: Recent state policy changes affecting the availability of assistance for low-income families, GAO-03-588. Washington, DC7 Author. Giesbrecht, L. H., Kulp, D. W., & Starer, A. W. (1996). Estimating coverage bias in RDD samples with Current Population Survey data. Proceedings of the Survey Research Methods Section, American Statistical Association (pp. 503 – 508). Han, W., & Waldfogel, J. (2001). Child care costs and women’s employment: A comparison of single and married mothers with preschool children. Social Science Quarterly, 82, 552 – 568. Hofferth, S. L. (1995). Caring for children at the poverty line. Children and Youth Services Review, 17, 61 – 90. Hogan, D. P., Msall, M. E., Rogers, M. L., & Avery, R. C. (1997). Improved disability population estimates of functional limitation among children 5–17. Maternal and Child Health Journal, 1, 203 – 216. Iceland, J. (2003, July). Dynamics of economic well-being: Poverty 1996–1999. Current Population Reports. Washington, DC7 U.S. Department of Commerce. Judkins, D., Brick, M. J., Broene, P., Ferraro, D., & Strickler, T. (2000). 1999 NSAF sample design: Report No. 2. Washington, DC7 The Urban Institute Press. Kamerman, S. B. (1995). Gender roles and family structure changes in the advanced industrialized west: Implications for social policy. In K. McFate, R. Lawson, & W. J. Wilson (Eds.), Poverty, inequality, and the future of social policy: Western states in the new world order (pp. 231 – 256). New York7 Russell Sage Foundation. Knox, V. W., London, A. S., & Scott, E. K. (2003). Welfare reform, work, and child care: The role of informal care in the lives of low-income women and children. Retrieved September 7, 2004 from http://www.mdrc.org/ publications/353/policybrief.html Larner, M., & Phillips, D. (1994). Defining and valuing quality as a parent. In P. Moss, & A. Pence (Eds.), Valuing quality in early child care services: New approaches to defining quality (pp. 43 – 60). London7 Paul Chapman Press. Lichter, D. T., & Eggebeen, D. J. (1994). The effect of parental employment on child poverty. Journal of Marriage and the Family, 56, 633 – 645. Loeb, S., Fuller, B., Kagan, S. L., Carrol, B., Carroll, J., & McCarthy, J. (2003). Child care in poor communities: Early learning effects of type, quality and stability, working paper 9954. Cambridge, MA7 National Bureau of Economic Research. Lowe, E. D., & Weisner, T. S. (2004). You have to push it—who’s gonna raise your kids?: Situating child care and child care subsidy use in the daily routines of lower income families. Children and Youth Services Review, 26, 143 – 171. Lukemeyer, A., Meyers, M. K., & Smeeding, T. (2000). Expensive children in poor families: Out-of-pocket expenditures for the care of disabled and chronically ill children in welfare families. Journal of Marriage and the Family, 62, 399 – 415. Meyers, M. K., Heintze, T., & Wolf, D. A. (2002). Child care subsidies and the employment of welfare recipients. Demography, 39, 165 – 179. Neely-Barnes, S., & Marcenko, M. (2004). Predicting impact of childhood disability on families: Results from the 1995 NHIS Disability Supplement. Mental Retardation, 42, 284 – 293. Olson, K., & Pavetti, L. (1996). Personal and family challenges to the successful transition from welfare to work. Washington, DC7 Urban Institute. Park, J., Turnbull, A. P., & Turnbull, H. R. (2002). Impacts of poverty on quality of life in families of children with disabilities. Exceptional Children, 68, 151 – 170. Perrin, J. M. (2002). Health services research for children with disabilities. The Milbank Quarterly, 80, 303 – 324. Research Triangle Institute. (2001). SUDAAN user’s manual, release 8.0. Research Triangle Park, NC7 Author. Safir, A., Scheuren, F., & Wang, K. (2000). Survey methods and data reliability, 1997 and 1999. Washington, DC7 The Urban Institute Press. Schulman, K. (2000). The high cost of child care puts quality care out of reach for many families. Washington, DC7 Children’s Defense Fund. Shearn, J., & Todd, S. (2000). Maternal employment and family responsibilities. Journal of Applied Research in Intellectual Disabilities, 13, 109 – 131. Shlay, A. B., Weinraub, M., Harmon, M., & Tran, H. (2004). Barriers to subsidies: Why low-income families do not use child care subsidies. Social Sciences Research, 33, 134 – 157.
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
919
Smith, K. (2000). Who’s minding the kids? Child care arrangements, Fall 1995, Current Population Reports, P70-90. Washington, DC7 U.S. Census Bureau. State Policy Documentation Project. (2000, July). The TANF child care protection. Retrieved October 11, 2004 from http://www.spdp.org/tanf/TANF_CC_protection.pdf Thompson, T. S., Holcomb, P. A., Loprest, P., & Brennan, K. (1998). State welfare-to-work policies for people with disabilities. Washington, DC7 Urban Institute. U.S. Census Bureau. (2001, October). Age: 2000. Washington, DC7 Author (Retrieved September 15, 2004 from http://www.census.gov/prod/2001pubs/c2kbr01-12.pdf). Waldfogel, J. (1997). The effect of children on women’s wages. American Sociological Review, 62, 209 – 217. Zigler, E. F., & Gilman, E. (1996). Not just any care: Shaping a coherent child care policy. In E. F. Zigler, S. L. Kagan, & N. W. Hall (Eds.), Children, families and government: Preparing for the twenty-first century (pp. 94 – 116). Cambridge7 Cambridge University Press. Zigler, E. F., & Lang, M. E. (1991). Child care choices: Balancing the needs of children, families and society. New York7 The Free Press.
Child care, disability, and family structure: Use and quality in a population-based sample of low-income preschool children Susan L. Parisha,*, Jennifer M. Clouda, Jungwon Huha, Ashley N. Henningb a
School of Social Work, University of North Carolina at Chapel Hill 301 Pittsboro Street, CB 3550 Chapel Hill, NC 27599-3550, United States b School of Social Work University of Wisconsin—Whitewater, United States Received 17 October 2004; received in revised form 1 December 2004; accepted 2 December 2004
Abstract The National Survey of America’s Families (NSAF) was analyzed to examine the use and quality of child care of low-income preschool children with disabilities as contrasted to low-income nondisabled children. Family structure is a stronger predictor of child care use than disability status. Disabled and nondisabled children living with single parents show similarly elevated rates of participation in child care. Important differences were found in the use and quality of child care. Our findings related to the extremely low cost of care for disabled children living with single parents may suggest particularly deleterious developmental outcomes for these children. These findings suggest the need for child care subsidies directed at low-income disabled children and their families. Further, the protective enforcement of minimum standards of care may require further analysis. D 2004 Elsevier Ltd. All rights reserved. Keywords: Child care; Children with disabilities; Family structure; Welfare
* 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 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2004.12.007
906
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
1. Introduction The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 failed to excuse parents of disabled children from the mandatory work required in order to receive benefits. In contrast, the AFDC program had recognized the elevated care needs of children with disabilities and included provisions exempting their parents from work requirements. Thus, PRWORA heralded a major change for low-income families of children with disabilities. Under PRWORA guidelines, states have discretion to exempt 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). All states are prohibited from terminating cash payments to single parents who are unable to find child care for a child under age six, and states have the discretion to exempt other parents. Fourteen states offer this so-called child care protection to parents of children with disabilities (State Policy Documentation Project, 2000). States also may exempt parents whose responsibilities to provide care for a disabled household member prevent them from working, and 22 states employ at least part of this exemption (State Policy Documentation Project, 2000). Since PRWORA increases the emphasis on employment of all low-income parents, the availability of child care, along with other factors affecting employment, is vital in order to participate in TANF. Researchers have examined the following prerequisites of employment: labor market conditions, parents’ training and readiness, and availability of child care (e.g., Blau & Tekin, 2001; Cancian & Meyer, 2000; Olson & Pavetti, 1996). Child care is a necessary precondition of parental employment, but the use of child care for lowincome disabled children is unknown. Child care for disabled children is a critical issue due to the sheer number of disabled children. An estimated 12% of children aged 5–17 years (Hogan, Msall, Rogers, & Avery, 1997) or approximately 6.6 million children in 2000 (U.S. Census Bureau, 2001) have a disabling condition. Furthermore, children with disabilities are significantly more likely to live in impoverished households: 28% of disabled children live in households with income below the federal poverty level (FPL), 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 is vital to policy makers and practitioners interested in facilitating the employment of these parents. This paper explores the child care use of low-income children with disabilities and for children stratified by whether they live in single- or two-parent households. The three research questions are: (1) What are the types, general costs, and hours of use of child care by low-income preschool children with disabilities in the United States? (2) How does family structure influence the child care used by low-income 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?
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
907
2. Background 2.1. Child care for the general child population Disabled and nondisabled children have similar needs regarding availability of child care, and thus an examination of the literature on child care for the general population is informative. In the United States, nonparental child care is widely utilized by working parents. The vast majority (about 75%) of children under five years of age were in some form of regular child care in 1995 (Smith, 2000). Child care is generally provided in three settings: the child’s home, a family day care home (kinship or nonkinship home), or a day care center (Zigler & Lang, 1991). This seemingly simple categorization belies enormous diversity of caregiver age, training, and experience; caregiver–child relationships; facility size and licensure; and ultimately, the quality of care (Zigler & Lang, 1991). Due to the extensive amount of time children spend in child care, it is, arguably, one of the four primary social systems, along with families, schooling, and health care, which interact to determine children’s development (Zigler & Gilman, 1996). The increase in mothers’ employment during the last decades is evident from the majority of young children who are in some form of regular child care (Kamerman, 1995). Because mothers are typically the primary caregivers for their children, concern has grown over the effect of increased mothers’ employment and use of child care arrangements on children’s well-being (Brandon & Hoffert, 2003). Quality of care is associated with both improved cognitive and social development, and existing research indicates high quality care promotes better outcomes in these domains (Child Care Bureau, 1999; Loeb et al., 2003). However, the United States system of child care is frequently characterized as being in a state of crisis due to concerns about the supply, cost, and quality of care (Blau, 2001; Zigler & Lang, 1991). Yet, the extent to which these issues affect low-income children with disabilities is unclear. The cost of child care is among the most significant expenditures that families face in raising their children—especially for low-income families. Across the United States, costs for center-based child care range between the averages of US$4000–6000 for a four-year old and can exceed US$10,000 annually (Schulman, 2000). Whereas, non-poor families spend an average of 7% of their income on child care (Smith, 2000), families living below the federal poverty level spend an average of 35% of their total income on child care (Smith, 2000). 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 cost ensures quality of care (Blau, 2001). We argue that although high cost cannot assure high quality, it is logical to believe that care obtained at substantially lower cost is unlikely to be of high quality and employing this factor as a proxy for quality is a sound exploratory strategy. Past research has found upper-income families to have the greatest access to child care programs. Their financial resources enable these parents to select high quality care for their children while they work. Middle- and upper-income parents define quality child care in terms of nurturing and experienced providers who provide their children with a safe environment that is cognitively enriching (Larner & Phillips, 1994). Low-income parents share the same desires for and definitions of quality care for their children but have difficulty
908
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
obtaining high-quality child care arrangements because of issues of cost, availability, and schedule flexibility (Brandon & Hoffert, 2003; Larner & Phillips, 1994). For low-income families, having affordable, reliable, and stable child care arrangements is crucial for job retention and financial well-being (Hofferth, 1995; Meyers, Heintze, & Wolf, 2002). 2.2. Child care for children with disabilities While a great deal is known about child care for nondisabled children, relatively little is known about disabled children’s use of child care (Buysse, Wesley, Bryant, & Gardner, 1999; Zigler & Lang, 1991). We describe in this section the existing research including use and quality of care, and the barriers families face in securing care for their children with disabilities. 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, just 34% of centers in a representative, statewide sample enrolled one or more children with disabilities (Buysse et al., 1999). In another state, nearly one-third of parents reported having been denied child care due to their child’s disability, and 23% of parents who lacked child care reported they were still seeking it for their disabled child (Cutler & Gilkerson, 2002). The only nationally representative study of child care use by mothers of children with disabilities found the severity of a child’s impairments, and whether or not the child had behavioral or emotional problems predicted hours of child care use (Brandon, 2000). However, this study also had important limitations. It did not examine low-income families’ cost or quality of care, or number of care arrangements. In addition, this study used data from 1986–88 and the impacts of critical changes related to PRWORA were not measured. Zigler and Lang (1991) have identified a host of barriers parents face in securing child care for their disabled children including inadequate numbers of trained caregivers who can effectively meet disabled children’s needs, prejudice and fear about disability, limited knowledge regarding the nature of disabilities, 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 (Cuskelly, Pulman, & Hayes, 1998; Shearn & Todd, 2000). A number of major methodological problems plague the existing research on disabled children’s care and limit our knowledge. For example, in most of the research, samples were small and specific to a single site. In addition, selection biases undermine our ability 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). Most importantly, these studies relied on middle- and upper-income parents, whose resources, expectations, and experiences likely differ in important ways from those of lowincome parents. 2.3. 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 into the proper context. Current child care policy for low-
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
909
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, parents of preschoolers are required to work 20 hours a week, but increased requirements for work participation are integral to both the current House and Senate TANF reauthorization bills. The House bill would expand work participation to 40 hours per 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 hours, or to 24 hours for single mothers of preschoolers. Neither bill provides further work exemptions for parents of children with disabilities, so existing state policies are unlikely to change (Fremstad & Parrott, 2004). Elevated work requirements will likely 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 (Han & Waldfogel, 2001; Meyers et al., 2002). Pending TANF reauthorization legislation will also affect CCDF. Both the House and Senate bills increase federal funding for child care provided to the states via CCDF. The proposed Senate bill would add US$7 billion and HR 4 would add more than US$1 million immediately and US$200 million annually for the next five years (Fremstad & Parrott, 2004). However, neither version is entirely sufficient. The proposed House increase is inadequate to maintain current child care levels, much less address the increased demand for child care that will result from increased TANF work requirements. The pending Senate bill would maintain existing coverage but would not increase the number of child care 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 (General Accounting Office, 2003). However, adequate and 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, with its limited hours of operation, can make traditional child care problematic (Ganow, 2000; Knox, London, & Scott, 2003). In addition, the financial instability that characterizes many low-income families, with cycles into and out of employment (Iceland, 2003), means that low-income 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 centers, which often rely 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 &
910
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
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 (Bromer & Henly, 2004). Ehrle, Adams and Tout (2001) found that roughly half of children under the age of three from low-income families were cared for by a relative, most often a grandparent. In addition, approximately one-third of these children were in care provided by another family (Ehrle et al., 2001). However, it is important to note that one study of child care in low-income communities showed participation in center-based care led to better school readiness and improved cognitive outcomes than either kinship care or family care homes (Loeb et al., 2003). 2.4. Family structure Families headed by a single parent have significantly lower income than those headed by two parents (Lichter & Eggebeen, 1994), fewer child care choices, and different patterns of child care utilization (Brandon & Hoffert, 2003; Ehrle et al., 2001). Studies comparing the child care arrangements of infants, toddlers, and school-aged children in single- and twoparent families have found that children from single-parent homes are more likely to be cared for by relatives, while children from two-parent homes are more likely to be cared for by their parents (Brandon & Hoffert, 2003; Ehrle et al., 2001). Parental care is more likely because partners in two-parent families have greater flexibility to arrange their work schedules to share child care responsibilities. Ehrle et al. (2001) also found children from single-parents homes were in child care for more hours per week than children from twoparent homes (Ehrle et al., 2001). Therefore, there is some evidence that family structure has impact on child care use: children from single-parent homes are more likely to be cared for by relatives and to be in full-time child care than children living with two parents. Completely missing from the research is the child care use of low-income families with disabled children and how such care varies by family structure. While these families are among those directly affected by TANF, we know nothing about the cost, quality, amount of use, or type of care in these families. Given this lack of information, it is impossible to determine appropriate policy measures. The present research was undertaken 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
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
911
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 NASF sub-sample for this study included families with preschool children under the age of six 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 knowledgeableQ about the child, in most cases the mother, provided responses to all questions about the child. 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 byesQ, children were considered to have a disability; for reports of bnoQ, children were considered to be nondisabled. The present study sample included 5065 children, including 321 disabled and 4744 nondisabled children. When weighted, they represented 228,000 disabled and 2.5 million nondisabled children. 3.3. Measures Several measures of child care use, cost, and quality were used to describe whether a child was in care, the number of different care arrangements a child used each week, the number of hours a child spent in care per week, expenditures for child care the previous month, and whether a child’s primary care arrangement was a center, family care or care provided by a relative. To examine quality of care, for which there is no direct measure, two proxy measures were created. For children in center-based care, the number of children per adult caregiver was calculated. This ratio is part of the standards used to evaluate quality by state licensing agencies and the National Association for the Education of Young Children (NAEYC) which accredits child care programs nationally (Blau, 2001; Commission on NAEYC Early Childhood Program Standards, 2004). Hourly costs of care were computed by dividing monthly expenditures by the total hours of care a child received per month. 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 Taylor-series linearization to appropriately estimate variance with survey data derived from complex sampling designs (Research Triangle Institute, 2001) such as the NSAF
912
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
Table 1 Description of sample characteristics Child age 0–3 4–5
Disabled n=321 (%)
Nondisabled n=4744 (%)
162 (50.5) 159 (49.5)
2983 (62.9) 1761 (37.1)
Total number of children in household b17 years of age* 1–2 161 (50.2) 3–4 132 (41.1) 5+ 28 (8.7)
2723 (57.4) 1689 (35.8) 323 (6.8)
Mother’s highest degree lower than high school high school/some college college graduate
99 (34.3) 171 (59.2) 19 (6.6)
1366 (30.6) 2641 (59.1) 459 (10.3)
Combined household income bFPL** 100–199% of the FPL**
146 (45.5) 175 (54.5)
1815 (38.3) 2929 (61.7)
Child race/ethnicity White Black Latino Others
144 84 78 15
2243 1049 1304 148
Child gender Female Male
121 (37.7) 200 (62.3)
2397 (50.5) 2347 (49.5)
Family structure Single-parent Two-parent
149 (46.4) 172 (53.6)
1899 (40.1) 2841 (59.9)
(44.9) (26.2) (24.3) (4.7)
(47.3) (22.1) (27.5) (3.1)
* Includes respondent children. ** Federal poverty level (FPL), calculated based on numbers of individuals living in household and combined income from all sources (U.S. DHHS, 2004).
(Safir et al., 2000). Analysis of covariance (ANCOVA) and multivariate logistic regression were the primary analytic strategies. For the ANCOVA results, we present parameter estimates, adjusted for the covariates in the models, and present Wald F-scores for each overall 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 single-parent homes; (2) disabled children in two-parent homes; (3) nondisabled children in singleparent homes; and (4) nondisabled children in two-parent homes. Logistic regression models were estimated for binary dependent measures (e.g., in child care) and predicted probabilities were calculated from these. For ease of interpreting the
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
913
Table 2 Child care of low-income children by disability status and family structure, adjusted for child age, maternal education level and number of children living in household Outcome measure
Disabled child with single-parent n=149
Number of care arrangements Hours in care per week Number of children in center Monthly expenditure for care Hourly cost of care Children per adult in center
1.20a 40.1a,b 11.2 US$179a US$1.24a,b 5.4a
In some form of child care Center is primary form of care Relative is primary form of care
78%a 29%a 35%
Disabled child with two-parents n=172
Nondisabled child with single-parent n=1899
Nondisabled child with two-parents n=2841
0.75b 23.9 13.8 US$271 US$2.20 4.6a
1.16b 33.2a 12.8 US$250a US$2.60a 6.0
0.74a 22.5b 12.9 US$225 US$2.51b 6.2
79%b 28% 31%
54%a 15%a,b 22%
Mean
Test statistic
Wald F
Predicted probabilities 59%b 29%b 19%
21.7** 21.9** 1.0 1.9* 8.1* 2.0* Wald F 23.5** 11.9*** 4.0
Statistically significant and trend-level group differences are indicated by alphabetic superscripts for each measure. * pb0.05. ** pb0.01. *** pb0.001.
logistic regression estimates, we report our results 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. These probabilities were obtained by solving the logit equation for the probability of being in 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. All of 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 under age six living in the United States in 1999.
4. Results The sample’s demographic characteristics are provided by the descriptive statistics in Table 1. Within this low-income sample, disabled children were poorer than nondisabled children: 45.5% of the disabled sample had family earnings below the federal poverty line
914
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
while 38.3% of the nondisabled children had family earnings below the federal poverty level (X 2=6.61; pb0.01). 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 (data not shown). The likelihood of a child being in care at all is more strongly related to family structure than to disability status. Similar rates of child care participation were found for children living with single parents regardless of the child’s disability status (78% of disabled children and 79% of nondisabled children in single-parent homes were in some form of child care). Rates of child care participation were also closely aligned for the children, disabled or nondisabled, living with two parents (59% and 54%, respectively). However, nondisabled children living with two parents were much less likely to use a center as a primary form of care than disabled children were (15% and 19%, respectively, F=11.9, pb0.001). Statistically significant group differences were not found in the likelihood that the primary form of care was provided by a relative. Disabled and nondisabled children who lived with single parents had significantly more care arrangements than children who lived with two parents. Disabled children living in single-parent homes spent significantly more hours (40 hours per week) in care than either group of children living in two-parent homes, who had means of 23–24 hours in care per week. Analyses related to center-based care excluded children who did not attend centers. For children attending center-based care, differences were not found in the size of the centers, as measured by the total number of children participating in care. Trend-level differences were found in the monthly cost of care borne by single-parent families. Single parents of disabled and nondisabled children paid US$179 and US$250 monthly, respectively, for child care. There were also trend-level differences found regarding the amount two-parent families paid for child care in the previous month: families of disabled children paid an average of US$271 compared to care costs of US$225 for nondisabled children. Statistically significant differences were not found among the other groups. Two measures were employed related to the quality of care received, hourly cost of care and caregiver ratios. Trend-level differences were found in the hourly cost of care paid by single parents of disabled children. Single parents of disabled children paid a mean of US$1.24 per hour, while single parents of nondisabled children paid a mean of US$2.60 per hour ( F=8.1, pb0.05). The ratio of adult caregivers to children in center-based care provides a second quality indicator. Differences in the caregiver ratios were not found for children living in singleparent homes, but trend-level differences ( F=2.0, pb0.05) were found between the children living in two-parent homes. Disabled children living with two parents had a mean of 4.6 children per adult caregiver, as compared with 6.2 children per adult for the nondisabled children living with two parents.
5. Discussion This study was developed to begin to illuminate the child care used by low-income preschool children with disabilities. It constitutes the first nationally representative
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
915
investigation of child care for low-income children with disabilities. However, a number of inherent limitations warrant consideration to fairly interpret our results. First, the relationship between parental employment and use of child care for disabled and nondisabled children cannot be directly measured because the sample of children drawn from the NSAF data was randomly selected. It is possible that the nondisabled children considered in our sample might have had disabled siblings, whose impairments influenced their parents’ employment, and thereby would have caused biased employment estimates. Second, due to the small sample size of disabled children, we were unable to examine how the use of child care varies by racial or ethnic group. This is significant as found by NeelyBarnes and Marcenko (2004) who present compelling evidence that race was an important predictor of the impact, particularly financial, that disabled children have on their families. Given this potential impact on family resources, the child care arrangements for minority children with disabilities could be different than what is presented here. Finally, the magnitude of impact on families of having children with disabilities depends partly on the severity of the children’s disabilities (e.g., Lukemeyer, Meyers, & Smeeding, 2000). Since the NSAF did not collect information on disability severity, we were unable to analyze its influence and we may have missed nuances in child care related to the severity of children’s impairments. However, children with milder impairments are less likely to be represented in this sample because mild impairments (e.g., learning disabilities, ADHD) typically are not diagnosed until children enter school (Batshaw, 2002) and our sample consisted of preschool children. In terms of overall use of child care, we found differences between low-income preschoolers with and without disabilities, but family structure is also critically important. On some measures, like general use of care, family structure is a more important predictor of child care than children’s disability status. These findings are at odds with previously reported research in which mothers reported being unable to find child care for their disabled children (e.g., Cuskelly et al., 1998; Shearn & Todd, 2000). Previous research has typically used nonprobability samples and has recruited participants from middle-class families. However, it is important to note that our probability sample consisted exclusively of low-income children (those living in households with income below 200% of the federal poverty level). Although no differences were found in the size of the centers low-income disabled and nondisabled children attended, there were other notable differences among the groups. Disabled children living in single-parent homes were in care for considerably more hours each week than their nondisabled counterparts, and the amount spent per month on their care was substantially lower than the amount expended for other children. Although child care quality cannot be measured directly with these data, we can speculate about the importance of some of these measures for the quality of child care disabled children receive. In terms of the number of children per caregiver, there was a trend-level likelihood that disabled children living with two parents had fewer children per adult caregiver, as compared with 6.2 children per adult for the nondisabled children living with two parents. For this measure, fewer children per adult caregiver typically represent better quality care (Commission on NAEYC Early Childhood Program Standards, 2004). Our finding regarding the singularly low hourly costs of care for disabled children in single-parent homes suggests the care these children receive may be of questionable
916
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
quality. We argue it is highly unlikely that similar quality care is being received at such disparate 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. Doubtless these single parents endure added stress and obstacles in managing multiple care arrangements, a situation complicated by their child’s impairments and one which usually necessitates more specialized care (Perrin, 2002). Coordinating care across numerous providers increases the risk of adverse developmental outcomes for disabled children whose impairments make them fragile and more vulnerable to inadequate care. Our findings represent an important first step in understanding the use of child care for low-income disabled children: they suggest low-income children with disabilities who live with a single parent may be at greater risk for adverse outcomes than other children. Our results also point to the importance of examining the family structure context in which children live. Aggregating these children only into disabled and nondisabled groups would have masked some of the important group differences we 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, emotional and behavioral problems, and reduced educational attainment (Brooks-Gunn & Duncan, 1997). Poverty may have even more deleterious effects for disabled children than 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). To be effective, public income support and child care policies must respond to the unique issues of disabled children. In response to the recognition of child care as a prerequisite for maintaining employment, expanding the availability of child care has become an important conduit for the national priority of increasing the employment of low-income parents. Low-income parents of disabled children are not exempted from TANF’s mandatory work requirements. However, our findings indicate children with disabilities of low-income single parents are spending substantially more time in child care than other children and their care is likely 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, our results support expanding existing child care subsidies for low-income disabled children. Our results also suggest that policies should be put in place to ensure minimum care standards for disabled children. Moreover, these exploratory findings clarify the need
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
917
for further research to fully understand the child care needs and barriers facing low-income children with disabilities and their families. 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 assistance 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 Batshaw, M. L. (2002). Children with disabilities. (5th ed.). Baltimore7 Brookes. 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, Germany7 Institute for the Study of Labor. Brandon, P. D. (2000). Child care utilization among working mothers raising children with disabilities. Journal of Family and Economic Issues, 21, 343 – 364. Brandon, P. D., & Hofferth, S. L. (2003). Determinants of out-of-school childcare arrangements among children in single-mother and two-parent families. Social Science Research, 32, 129 – 147. Bromer, J., & Henly, J. R. (2004). Child care as family support: Caregiving practices across child care providers. Children and Youth Services Review, 26, 941 – 964. Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. The Future of Children, 7(2), 55 – 71. Buysse, V., Wesley, P. W., Bryant, D., & Gardner, D. (1999). Quality of early childhood programs in inclusive and noninclusive settings. Exceptional Children, 65, 301 – 314. Cancian, M., & Meyer, D. R. (2000). Work after welfare: Work effort, occupational and economic well-being. Social Work Research, 24, 69 – 86. Child Care Bureau. (1999). Access to child care for low-income working families. Washington, DC7 Author (Available at: http://www.acf.dhhs.gov/ programs/ccb/ research/ccreport/ccreport.htm). Commission on NAEYC Early Childhood Program Standards. (2004). Final draft: Early childhood program standards and accreditation performance criteria. Washington, DC7 Author. Cuskelly, M., Pulman, L., & Hayes, A. (1998). Parenting and employment decisions of parents with a preschool child with a disability. Journal of Intellectual and Developmental Disability, 23, 319 – 333. Cutler, A., & Gilkerson, L. (2002). Unmet needs project: A research, coalition building, and policy initiative on the unmet needs of infants, toddlers, and families. Chicago, IL7 University of Illinois at Chicago, Department of Disability on Human Development. Ehrle, J., Adams, G., & Tout, K. (2001). Who’s caring for our youngest children? Child care patterns of infants and toddlers. Occasional Paper, vol. 42. Washington, DC7 Urban Institute. Fremstad, S., & Parrott, S. (2004). The Senate Finance Committee’s TANF reauthorization bill. Washington, DC7 Center on Budget and Policy Priorities. Fujiura, G. T., & Yamaki, K. (2000). Trends in demography of childhood poverty and disability. Exceptional Children, 66, 187 – 199. Ganow, M. (2000). Child care subsidies: Strategies to provide outreach to eligible families. Welfare Information Network Issue Notes, 4 (Retrieved June 25, 2004 from http://www.welfareinfo.org/childcaresubsidiesissuenote.htm).
918
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
General Accounting Office. (2003, May). Child care: Recent state policy changes affecting the availability of assistance for low-income families, GAO-03-588. Washington, DC7 Author. Giesbrecht, L. H., Kulp, D. W., & Starer, A. W. (1996). Estimating coverage bias in RDD samples with Current Population Survey data. Proceedings of the Survey Research Methods Section, American Statistical Association (pp. 503 – 508). Han, W., & Waldfogel, J. (2001). Child care costs and women’s employment: A comparison of single and married mothers with preschool children. Social Science Quarterly, 82, 552 – 568. Hofferth, S. L. (1995). Caring for children at the poverty line. Children and Youth Services Review, 17, 61 – 90. Hogan, D. P., Msall, M. E., Rogers, M. L., & Avery, R. C. (1997). Improved disability population estimates of functional limitation among children 5–17. Maternal and Child Health Journal, 1, 203 – 216. Iceland, J. (2003, July). Dynamics of economic well-being: Poverty 1996–1999. Current Population Reports. Washington, DC7 U.S. Department of Commerce. Judkins, D., Brick, M. J., Broene, P., Ferraro, D., & Strickler, T. (2000). 1999 NSAF sample design: Report No. 2. Washington, DC7 The Urban Institute Press. Kamerman, S. B. (1995). Gender roles and family structure changes in the advanced industrialized west: Implications for social policy. In K. McFate, R. Lawson, & W. J. Wilson (Eds.), Poverty, inequality, and the future of social policy: Western states in the new world order (pp. 231 – 256). New York7 Russell Sage Foundation. Knox, V. W., London, A. S., & Scott, E. K. (2003). Welfare reform, work, and child care: The role of informal care in the lives of low-income women and children. Retrieved September 7, 2004 from http://www.mdrc.org/ publications/353/policybrief.html Larner, M., & Phillips, D. (1994). Defining and valuing quality as a parent. In P. Moss, & A. Pence (Eds.), Valuing quality in early child care services: New approaches to defining quality (pp. 43 – 60). London7 Paul Chapman Press. Lichter, D. T., & Eggebeen, D. J. (1994). The effect of parental employment on child poverty. Journal of Marriage and the Family, 56, 633 – 645. Loeb, S., Fuller, B., Kagan, S. L., Carrol, B., Carroll, J., & McCarthy, J. (2003). Child care in poor communities: Early learning effects of type, quality and stability, working paper 9954. Cambridge, MA7 National Bureau of Economic Research. Lowe, E. D., & Weisner, T. S. (2004). You have to push it—who’s gonna raise your kids?: Situating child care and child care subsidy use in the daily routines of lower income families. Children and Youth Services Review, 26, 143 – 171. Lukemeyer, A., Meyers, M. K., & Smeeding, T. (2000). Expensive children in poor families: Out-of-pocket expenditures for the care of disabled and chronically ill children in welfare families. Journal of Marriage and the Family, 62, 399 – 415. Meyers, M. K., Heintze, T., & Wolf, D. A. (2002). Child care subsidies and the employment of welfare recipients. Demography, 39, 165 – 179. Neely-Barnes, S., & Marcenko, M. (2004). Predicting impact of childhood disability on families: Results from the 1995 NHIS Disability Supplement. Mental Retardation, 42, 284 – 293. Olson, K., & Pavetti, L. (1996). Personal and family challenges to the successful transition from welfare to work. Washington, DC7 Urban Institute. Park, J., Turnbull, A. P., & Turnbull, H. R. (2002). Impacts of poverty on quality of life in families of children with disabilities. Exceptional Children, 68, 151 – 170. Perrin, J. M. (2002). Health services research for children with disabilities. The Milbank Quarterly, 80, 303 – 324. Research Triangle Institute. (2001). SUDAAN user’s manual, release 8.0. Research Triangle Park, NC7 Author. Safir, A., Scheuren, F., & Wang, K. (2000). Survey methods and data reliability, 1997 and 1999. Washington, DC7 The Urban Institute Press. Schulman, K. (2000). The high cost of child care puts quality care out of reach for many families. Washington, DC7 Children’s Defense Fund. Shearn, J., & Todd, S. (2000). Maternal employment and family responsibilities. Journal of Applied Research in Intellectual Disabilities, 13, 109 – 131. Shlay, A. B., Weinraub, M., Harmon, M., & Tran, H. (2004). Barriers to subsidies: Why low-income families do not use child care subsidies. Social Sciences Research, 33, 134 – 157.
S.L. Parish et al. / Children and Youth Services Review 27 (2005) 905–919
919
Smith, K. (2000). Who’s minding the kids? Child care arrangements, Fall 1995, Current Population Reports, P70-90. Washington, DC7 U.S. Census Bureau. State Policy Documentation Project. (2000, July). The TANF child care protection. Retrieved October 11, 2004 from http://www.spdp.org/tanf/TANF_CC_protection.pdf Thompson, T. S., Holcomb, P. A., Loprest, P., & Brennan, K. (1998). State welfare-to-work policies for people with disabilities. Washington, DC7 Urban Institute. U.S. Census Bureau. (2001, October). Age: 2000. Washington, DC7 Author (Retrieved September 15, 2004 from http://www.census.gov/prod/2001pubs/c2kbr01-12.pdf). Waldfogel, J. (1997). The effect of children on women’s wages. American Sociological Review, 62, 209 – 217. Zigler, E. F., & Gilman, E. (1996). Not just any care: Shaping a coherent child care policy. In E. F. Zigler, S. L. Kagan, & N. W. Hall (Eds.), Children, families and government: Preparing for the twenty-first century (pp. 94 – 116). Cambridge7 Cambridge University Press. Zigler, E. F., & Lang, M. E. (1991). Child care choices: Balancing the needs of children, families and society. New York7 The Free Press.