Children with disabilities, like all youngsters, need love, stimulation, nurturing, companionship and fun in order to thrive. Finding quality child care that provides all of these things is crucially important, especially in the age of single parents and two-career families.

The Americans with Disabilities Act (ADA) of 1992 was designed to speed the integration of people with disabilities, both adults and children, into mainstream society. Places that provide child care, whether they be preschools, child-care centers or home-run centers, must meet the provisions set by the ADA. Families seeking child care may find that some change has taken place in this regard but much remains to be done.

Dayton Hudson Corp. funds a free nationwide phone service for those seeking child care. Parents may call (800) 424-2246 for information about local and statewide referral agencies that can help in finding suitable child care. Referral agencies vary greatly. Some provide the service for a fee and others at no cost. Some use computer data bases and others rely on shoeboxes full of index cards.

Finding care for children under 2 is generally difficult, more so when the child has a disability. A referral service may help prevent parents from making fruitless calls to centers that don't accept children under a certain age.

CARING ABOUT KIDS

"Child-care providers by and large really care about kids. They really want to do a good job," says Susan Eck, who works for the Blake Foundation, which helps train workers at Arizona child- care centers to incorporate children with disabilities.

"Some centers are aware of the ADA and some aren't so aware," Eck says. "A lot of times they realize they already include kids with disabilities and just hadn't identified them as such."

Eck advocates "inclusiveness" -- the concept of placing kids with and without disabilities in the same child-care setting. "Research shows that once children are participating in included settings, they make greater developmental gains, especially in socialization," she says.

When calling a child-care center, should a parent state right away that the child has a disability? Eck suggests that it's better to start by asking if the center has any vacancies. "Ask if you can make a visit," she says. "After the visit, if you feel your child will fit there, then it's time to bring up any special needs."

Centers often face difficulties because having a relatively small staff and large number of children doesn't allow one-on-one care. Children with disabilities may have feeding tubes or breathing difficulties that require close supervision. "There just isn't enough staff in these centers to go around," Eck says.

COMPLYING WITH THE ADA

How far do child-care providers have to go to accommodate children with disabilities? The ADA requires providers to make a "good-faith" effort, meaning they can't flatly turn a child away due to a disability. Moreover, they can't charge that child's parent more than other parents, even if the center has to make expensive changes, such as modifying the bathroom to accommodate the child. And they can't refuse a child because their liability insurance rates may increase.

For child-care centers, complying with the ADA could mean making architectural modifications or something as simple as changing snack preparation procedures or providing toys or games appropriate for children with disabilities.

Eck hasn't personally encountered a center that has flatly refused to accept children with disabilities, but she has heard reports of such turndowns.

The ADA allows child-care providers to say no if accepting a child would impose an undue financial hardship, such as a modification expense out of proportion to the resources of the center.

Providers can also say no if accepting a child will entail fundamentally altering their programs, or if the child's condition poses a health risk to others. But blanket turndowns are illegal, and each child must be considered individually.

LEGAL ACTION

What recourse do parents have if they are turned down? Probably the most sensible plan is to keep trying until a center is found that is right for the child. But parents also have the option of filing a complaint with the Justice Department, which can fine centers that fail to comply with the ADA.

Last December, the first such settlement was made in favor of Brenda Brock, whose daughter, Belinda, has cerebral palsy. Workers at the child-care center Belinda attended in Gillette, Wis., said they were afraid to take off the 4-year-old's braces at naptime. Belinda's mom felt that this policy violated her daughter's rights.

Rather than impose a heavy fine, the Justice Department ruled that the providers at Belinda's center must receive training to remove her braces and put them back on; certain low-cost architectural changes must be made; and children like Belinda who need diaper changing must not be held back with younger children.

Despite her victory, Brock opted not to return Belinda to the center. But the changes will benefit other children who are placed in the center.

SEARCHING

Belinda Brock's case is not unusual in that an unwillingness to adapt is often the greatest obstacle to inclusive care.

Sometimes, it may be the parents who have to reject center after center in search of a suitable environment. Cindy Parker, whose daughter, Sunday, has spinal muscular atrophy, visited a series of centers in Tucson. Though Sunday, 4, doesn't require a wheelchair, her mom noticed that many centers lacked the ramps and widened bathrooms necessary to be wheelchair accessible.

Parker turned down one center because the ratio of care providers to children was too low - a great concern for parents whose children require special care. Parker was worried that Sunday might be knocked over by the stronger children who were allowed to run around due to inadequate supervision.

Another center also had a poor supervisor to child ratio and, in addition, smelled of urine. Parker felt that a center with poor hygiene policies was dangerous for Sunday, who must avoid colds and infections because of her SMA.

But the third center Parker tried, Hand in Hand, turned out to be just right. "Sunday was the first child with a disability that they had," Parker says. "They asked questions, found out what her needs were and accommodated her very well."

The environment has been good for Sunday, who has made many friends. It's also benefited the non-disabled kids who attend the center. "They learn compassion on a far deeper level than most children do," Parker says.

"There are three reasons why you need to include," Susan Eck says. "Families want it. Research shows it's better for the kids if it's done well. And it's the law."

RESPITE CARE

Cory Carrier is 8 and has SMA. Thanks to the ADA, he attends a preschool that should help integrate him into the mainstream school system. On Wednesdays, Cory's condition requires him to stay home to rest, and his mother, Jamie, needs someone to take care of him. Because Cory is severely disabled, anyone who cares for him must know how to use a feeding tube and administer oxygen. "It's not as if I can rely on someone who has no training," Carrier says. Cory lives in a state that provides, at no cost to families, a special kind of assistance called "respite care." Trained individuals come to the home for a specified amount of time per month to care for or work with the special-needs child. Thanks to this service, Cory has his day home from preschool with a qualified caregiver at no cost to his family.

OTHER AVENUES

Finding a traditional baby sitter who's up to the challenge of caring for a child with a disability may be difficult, but not impossible. A parent who's willing to pay enough and invest time in training the individual may find a helpful resource that lasts for years. Although child-care centers run by religious organizations are exempt from the ADA, churches or other community organizations are still worth looking into as sources of child-care assistance. "Many of them have a volunteer pool where they'll have somebody come and spend time with your child while you go out to the grocery store or whatever," Jamie Carrier says. Sometimes state laws go further than the ADA in extending protection to those with disabilities. Check with your state Attorney General's office to find out the full extent of your child's rights.

SMALL STEPS

Improved compliance with the ADA and increased sensitivity to special youngsters may not require monumental changes on the part of child-care providers, maybe just a shift in attitude and a willingness to take what small steps are necessary. "If they just make little accommodations for them, it makes life so much easier," Cindy Parker says. "Just being there to make sure they're OK and catch them at the end of the slide." For more on child care and the ADA, contact the Child Care Law Center, 22 Second St., 5th Floor, San Francisco, CA 94105, or call (415) 495-5498. To find out more about agencies and resources available to parents, call the National Child Care Information Center at (800) 616-2242, or go online with the NCCIC Gopher at ericps.ed.uiuc.edu or the NCCIC World Wide Web site at http://ericps.ed.uiuc.edu/nccic/nccichome.html.