"Early Head Start has really helped me make my home safe and secure for my toddler. She is deaf and can't hear me when I tell her, 'Don't touch the hot stove,' or 'Be careful of the wet floor.' I've learned some ways to communicate with her using gestures and putting up picture cues." – Parent of a child with a disability in a home visiting program

This chapter highlights the safety practices that are vital to a coordinated approach for children with disabilities or special healthcare needs and their families. Your work as a disability services coordinator integrates with multiple systems and services to ensure the safety of children with disabilities.¹ Your key program partners are the health manager, who is responsible for the overall health and safety of the children, and the facilities manager, who oversees accessibility indoors and outdoors. Working together, you can create a culture of safety.

Key Ideas

• Keeping children safe is a top priority for all Head Start and Early Head Start programs.
• Safety and injury prevention are essential in providing services to children with disabilities.
• Staff share the responsibility of ensuring a safe, inclusive environment both indoors and outdoors on a daily basis.
• Partnering with families keeps children safe at home.
• Families' ideas about what is safe or not safe reflect their cultural backgrounds and their own experiences.
• Accessible facilities are integral to a coordinated approach to ensure full participation of children with disabilities and their families.
• To ensure all children with disabilities participate effectively and fully in all activities, a coordinated approach includes integration of safety practices throughout the program.

What are the safety practices in Head Start programs?

45 CFR §1302 Subpart B – Program Structure specifies staff-child ratios, group size maximums, and square footage requirements to ensure safe learning environments for children. If state licensing requirements differ from requirements in the HSPPS, a program must observe the strictest requirement.

Most HSPPS on safety practices appear in 45 CFR §1302 Subpart D – Health Program Services. A program must have a management system that includes policies and practices to make sure that all facilities, equipment and materials, background checks, safety training, safety and hygiene practices, and administrative safety procedures ensure child safety. The HSPPS require that staff with regular child contact attend initial orientation training within three months of hire and then ongoing training in health, safety, and child care requirements. Program management creates a disaster preparedness and response plan and includes it in staff training.

Other regulations also pertain to safety issues. Requirements about safe facilities appear in 45 CFR §1303 Subpart E – Facilities. When a new facility is completed, managers will need a final facility inspection. The report must certify that the facility complies with the access requirements of the ADA, Section 504, and other federal and local regulations. Safety regulations pertaining to vehicles and transportation of children appear in 45 CFR §1303 Subpart F – Transportation. Children who receive transportation services must learn safety procedures and participate in bus evacuation drills. 45 CFR §1302 Subpart J – Program Management and Quality Improvement requires staff to report any significant incident affecting the health and safety of program participants to the responsible U.S. Department of Health and Human Services (HHS) official immediately or as soon as possible.

HSPPS Related to Safety Practices

• Center-based option, 45 CFR §1302.21
• Home-based option, 45 CFR §1302.22
• Family child care option, 45 CFR §1302.23
• Safety practices, 45 CFR §1302.47
• Purpose, 45 CFR §1302.100
• Achieving program goals, 45 CFR §1302.102
• Inspection of work, 45 CFR §1303.56
• Safety procedures, 45 CFR §1303.74
• Children with disabilities, 45 CFR §1303.75

Planning for Partnerships

You are likely to collaborate with program management, the health manager, transportation and facilities managers, and other staff as you develop effective community partnerships.

• Reach out to healthcare providers, early intervention and special education providers, and other specialists.
• Create emergency preparedness and safety and injury prevention plans.
• Ensure the plans include accommodations needed for children with disabilities or special healthcare needs.
• Offer joint training opportunities about roles and responsibilities that keep children safe.
• Develop a communication protocol to inform program staff and partners about children's injuries and to provide consistent messages to parents and families.
• Include parents' and families' voices as you build partnerships.

What is your role in safety and injury prevention?

Keeping children safe is a top priority for all Head Start and Early Head Start programs. Children with disabilities and special healthcare needs may be more vulnerable to injuries. Also, they are more likely to sustain more serious injuries. As the disability services coordinator, you work with multiple systems and services to create a culture of safety. You continue to design and implement a coordinated approach that promotes the full and safe participation of children with disabilities and their families.

The safety regulations are broad and encompass many aspects that affect young children with disabilities and special healthcare needs. The leadership in your program has probably developed health and safety protocols or decided to use available checklists to ensure clean facilities and avoid dangerous situations on site. Making health and safety a priority begins at the top of your program; but, in fact, all staff are responsible for ensuring the safety of all children.

All staff ensure that no child is left unsupervised or at risk of injury. Staff must attend to children's behavior and potential hazards, with appropriate action taken immediately.

You and all program staff focus on anticipating hazards and individualizing to prevent injury. As children grow and change, the learning environment also changes. That's why periodic checks are necessary. Often, the direct providers who work with children are responsible for completing safety checklists. The managers make sure they are done in a timely fashion and that any identified issues are addressed. The manager might be a facilities manager, site or education supervisor, or center director. Also, work closely with transportation staff to ensure they have safety procedures in place for children with disabilities and that staff follow any special requirements in their IFSP or IEP.

Across all program types and all age groups in Head Start programs, active supervision is a key element in creating safe learning environments. As a disability services coordinator, you can help staff:

• Understand how to position themselves to observe all the children by watching, listening, and counting at all times
• Use their knowledge of each child's development and abilities to anticipate what they will do, and then get involved and redirect when necessary

Active supervision looks like this: A preschooler places a heavy truck on top of a shelf. A child with a mobility challenge is playing on the floor near the shelf. The truck presents a hazard because the child can't move quickly if the truck topples. The teacher must act immediately to move the truck to a safer spot.

With the health and the facilities managers, educational staff, and early intervention specialists and special educators, you can help develop approaches to adapt the learning environment so children with disabilities can participate safely. Think through the environment and the details of the children's disabilities, including physical, social and emotional, cognitive, and sensory needs. Consider all the settings where children spend time (e.g., in center- and home-based programs, indoors, and outdoors).

Partner with the family service staff and families to ensure homes are safe for young children with disabilities. Learn about the child's experiences at home. What safety measures do they have in place? Do they need help for a child with a walker, language delays, or mental illness? There may be times when you turn to health providers and specialists for suggestions.

The ELOF goals include "learning safe behaviors and demonstrating self-care in developmentally appropriate ways." Work with education staff to plan curriculum modifications or embed learning opportunities to promote these skills with children with disabilities and special healthcare concerns.

The ECLKC offers valuable resources about health and safety. Check out the latest webinars and safety guidelines. Also, the HSPPS recommend that a program consult Caring for Our Children (CFOC) Basics about implementing adequate safety policies and practices. For additional information and an explanation of the rationale behind evidence-based health and safety practices, consult the CFOC Online Standards Database.

Develop Specialized Safety Plans

Safety at Home

An infant has low muscle tone and her IFSP includes tummy time. You and the home visitor note that tummy time isn't happening. You take a look around the home and notice that the floor space is crowded. You work with the family to set up safe floor space in a corner, so they can feel confident about providing tummy time each day. Review helpful home safety guidelines.

Many children with disabilities need an individualized plan to ensure their safety and well-being. A child's IHP, IFSP, or IEP may or may not identify emergency procedures. You, other staff, and a child's parents and family might need to develop plans to accommodate these kind of situations.

• A child with an IEP has a disability related to hearing and sensory integration. He is frightened by loud noises, such as sirens and alarms. When the school building schedules a fire drill, teachers have a plan; but what is the plan for staff to support the child when the building has an unscheduled fire drill?
• A child walks with leg braces and moves slowly in comparison to the other children. If the child needs to make a quick exit from the classroom in an emergency, how can staff ensure the child's safety?
• A toddler with a visual impairment would not be able to see a hazard in the classroom or outdoor space in the same way as other children. How can teachers make sure the child knows about changes to the classroom or outdoor environment that could affect the child's safety?

Your program's emergency preparedness plan must address the safety of children with disabilities and special healthcare needs. Review the procedures in your program to ensure access to medications and special dietary items in the case of a shelter-in-place. Make sure these items are brought along in the event of an evacuation. In addition, some children with disabilities may require special transportation to properly evacuate.

Establish responsibilities during staff training and planning meetings before an emergency or drill to make sure staff are comfortable with the procedures. Reach out to your community partners, such as the fire department and paramedics. Inform them about children with disabilities who might need special assistance during a natural disaster or other community-wide emergency.

Children with disabilities who ride program vehicles may need specialized plans for emergency evacuation. The IHP, IFSP, or IEP may include these plans. Some children with limited physical mobility may need adult assistance getting in and out of the bus. Children with communication problems may become very confused and upset because they don't understand the instructions. Ensure all the adults involved in transportation know the specific procedures for a child with disabilities and have conducted the required evacuation drills.

Ready.gov offers guidance for emergencies, with specific considerations for children and adults with disabilities

Tips for Creating a Safe Environment and Preventing Injury

• Advocate for a program-wide culture of safety. Make it clear that safety is everyone's responsibility. The eyes and ears of all adults need to be tuned into preventing hazards and ensuring children's safety at all times.
• Conduct a safety check. Partner with education staff, home visitors, and their managers to conduct a safety check indoors, outdoors, and on program vehicles to identify hazards for children with disabilities and ensure that adaptations are in place.
• Work with the facilities management. Make sure the facilities meet ADA requirements.
• Emphasize the importance of active supervision. Review program policies and procedures to ensure adequate staffing indoors and outdoors and consistent implementation of active supervision strategies.
• Provide training. Ensure that all staff, volunteers, and consultants understand the importance of injury prevention and their role in active supervision.
• Plan for emergencies. Make sure your program's emergency plan includes plans for children with disabilities and special healthcare needs who may require an accommodation. Hold practice sessions, such as fire drills.
• Review home safety. Partner with families to ensure everyone knows how to maintain a safe home environment for their children with disabilities.
• Reach out to partners and local resources. Find out which resources address the safety issues of children with disabilities and special healthcare needs. Promote child safety throughout your community.

People to Help You

• Health manager and staff
• Facilities manager
• Transportation manager and staff
• Education manager and staff
• Program leadership
• Partners engaged in community safety, such as first responders
• Healthcare providers
• Part B, Part C, and related service providers
• Families

Questions to Ask Your Colleagues

• How do we ensure safe environments for children with disabilities and special healthcare needs? How do we engage families?
• How do we address hazards and risks to children with disabilities?
• What kinds of accommodations prevent injury to children with disabilities and special healthcare needs?
• What kinds of supports do we offer families to ensure safe environments at home and in the community?
• Do we have specialized emergency plans in place that ensure the safety of children with disabilities and special healthcare needs during a natural disaster or other situations?

Scenario

Janet is a disability services coordinator. She meets regularly with classroom teachers who want to ensure they provide the best learning opportunities for young children with disabilities. Because of a congenital condition, 4-year-old Carlos has mobility challenges and uses a walker. He is not eligible for IDEA services but has an IHP. The teachers feel comfortable assisting him in the classroom. They've modified the classroom environment so he can move around easily.

However, the teachers are concerned about his safety outdoors. What if other children run and bump into him? They are also worried he may get hurt going from the classroom to the playground. The children have to pass through a heavy door to reach the playground. Carlos moves slowly with his walker, and it takes him more time to get to there.

They also raise staffing concerns. Which teacher is going to keep an eye on the children who are already outside? Which teacher is going to hold the door for Carlos? Who is going to help Carlos navigate the steps? What if he falls and hurts himself? They don't think they have enough staff to provide adequate supervision, but they know how important it is for him to be engaged in outdoor activities with his classmates.

Janet appreciates the teachers' concerns about Carlos's safety. She affirms that safety is a priority for all children in Head Start programs. She brainstorms with the health manager, the facilities manager, and the teachers. Together, they come up with a few strategies:

• Classmates can help hold the door for Carlos
• A volunteer can assist during this transition time
• The health manager can reach out to Carlos's parents to find out more about the likelihood of his falling and inquire about fall prevention strategies and protective measures the program can implement
• Everyone can work together to create a safety plan for Carlos

Janet and the teachers meet the next week. They report on their successes. The other children want to help hold the outside door for Carlos and for their other friends, as well. The teachers designate this as a "job" on the job chart, because holding the door is a kind thing to do every day for all children. Janet contacts a volunteer organization. The teachers come up with a staffing plan that includes the volunteer helping when the children are outdoors. The health manager provides useful information from Carlos's primary care doctor and the parents.

The parents appreciate the concern and share that Carlos has fallen at home. They explain that playing outside is important for Carlos. They want him to have the same experiences as the other children in the classroom. Janet and the teachers are relieved to hear that perspective from Carlos's parents. The program team wants to have a plan in place so they will know what to do if Carlos falls, how much support to offer him, and how to help him navigate a possible tumble. Carlos's parents describe how they handle his falls at home. They have taught him how to get up after a fall and explain what kind of support he needs when he falls. They help write up a safety plan for the program. Next, the health manager shares the safety plan with Carlos's primary care provider for approval. The disability services coordinator, the health manager, and the education staff have worked together to ensure full participation for Carlos.

^{1 In this guide, the term children with disabilities refers also to children with suspected delays unless stated otherwise.}

Last Updated: June 25, 2020