Inclusive and Supportive Education Congress International Special Education Conference Inclusion: Celebrating Diversity? 1st - 4th August 2005. Glasgow, Scotland

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Preschool Inclusion in the United States: Cost, Quality and Outcomes

Samuel L. Odom
Indiana University
slodom@indiana.edu

Virginia Buysse
University of North Carolina at Chapel Hill
virginia_buysse@unc.edu

In the United States, early childhood intervention for three- to five-year old children with disabilities was first provided by the public school system and often occurred in special education classes that enrolled only children with disabilities.   Over the past decades, there has been a movement to include and provide services to children with disabilities in programs enrolling typically developing children (Guralnick, 2001).   Currently, more than 50% of the preschool-aged children with disabilities receiving publicly funded special education services are placed in an inclusive setting (U.S. Department of Education, 2003).   Children with disabilities have been included in programs operating in a number of organizational contexts (Odom et al., 1999) and actively participate in the range of activities in those settings (Brown, Odom, Li, & Zercher, 1999).   With the increase of preschool inclusion in the United States has come questions about the quality of early childhood services and settings, the developmental and social outcomes for children with disabilities, and the cost of inclusive programs.

Concerns about quality of inclusive programs have emanated from the broader concerns about the medium to low quality of the general early childhood environment in child care settings in the United States (Bailey, McWilliam, Buysse, & Wesley, 1998).   In the study of Cost, Quality, and Outcomes for young children who were typically developing, Peisner-Feinberg and Burchinal (1997) found quality of the early childhood environment to be relatively low in a national sample of child care setting.   Investigations of inclusive preschool programs in Virginia (LaParo, Sexton, & Synder, 1998) and North Carolina (Buysse, Wesley, Bryant, & Gardner, 1999), however, have found that the early childhood environments of inclusive program to be at or above average.   These studies have focused on the general early childhood environmental quality and have yet to examine the quality of inclusion for children with disabilities (i.e., how well integrated the child is into the center).   Given that preschool inclusion has been offered through different organizational models, the quality of inclusion for different models has not been addressed.

A natural question associated with concerns about quality was related to the developmental and social outcomes for children with disabilities enrolled in inclusive settings.   A primary rationale for inclusive placements was that they would provide greater opportunities for the development of social skills and social competence than would occur in traditional special education classes (Guralnick, 1990; Odom, 2000).   In addition, the assumption was that children with disabilities would make progress in other developmental areas as well.   From the research literature, it appeared generally that children with disabilities benefit from placement in inclusive settings and from specific interventions (Odom et al., 2004). To date, however, there has been very little research on the developmental and social outcomes of inclusion for children with disabilities enrolled in different organizational program models (Odom et al., 1999).

In addition to child outcomes, a major concern for administrators and policy makers was the cost of inclusive preschool programs.   In earlier research, Odom and colleagues (Odom, Hanson et al., 2001; Odom, Parrish, & Hikido, 2001) examined the cost of preschool inclusion, as it compared to traditional special education programs.   They found that generally, but not always, the cost of preschool inclusion was equal to or less than traditional special education programs.   In addition, it appeared that the cost varied with the inclusive program model used in a school district,   with some local education agencies (LEAs) paying for more services than other LEAs.   The questions related to cost for specific types of program model is still unresolved.  

The purposes of this study were to examine the quality of preschool environment, developmental outcomes for children, and costs of preschool inclusion. The primary research questions were: (1) What is the quality of the early childhood environments in inclusive settings? (2) What is the quality of the inclusive experiences for children with disabilities in inclusive settings? (3) What is the developmental progress of children with disabilities in inclusive settings? (4) How is quality of inclusive programs related to developmental progress and social performance of children with disabilities?

Method

Settings

            The study took place in inclusive preschool programs in the United States, in the states of North Carolina and Indiana.   At the beginning of the study, three types of program models were identified to guide program recruitment: community-based programs, Head Start programs, and public school programs.   Community-based programs (CB) were private child care programs operating outside of public schools systems; public schools routinely provided itinerant special education and related services in these settings.  In this model, an early childhood educator was the lead teacher. Head Start programs (HS) offered early childhood education program for children from low income families and also enrolled children with disabilities.   In this program type, a Head Start teacher was the lead teacher, or in some cases the role was shared by a teacher from the public schools and the Head Start teacher.   These programs often collaborated with public school programs in offering services for children with disabilities.   Public school programs (PS) also operated preschool programs enrolling typically developing children from the community, which they then included children with disabilities.   In these classrooms either an early childhood education teacher or a special education teacher was a lead teacher.   During the course of the study, a fourth model of service arose, in which one program blended resources across Head Start, Title 1, and public school sources; these were identified as Blended programs (BL).   In these programs, a certified teacher employed by the public schools was a lead teacher.

Child Participants

            Descriptions of the children who participated in the study can be located in Tables 1 and 2.   A total of 142 children with disabilities participated in the study, with the largest number of children enrolled in BL and CB programs.   The primary ethnic/racial groupings of students were Caucasian, African American, and Hispanic/Latino.   The means age of children ranged from 48 to 54 months and was not significantly different across programs.   In addition, the ABILITIES Index (Simeonsson & Bailey, 1998) was completed for each child.   The ABILITIES provided a rating of the severity of disabilities across nine domains and yields an overall severity of disability classification.   In the study, 70 children were grouped in the mild disability level, 39 were in the moderate disability level, and 34 were in the severe disability level.

Measures

            Three types of measures were collected.   These measures have been listed in Table 3.   The cost measures were adapted from instruments developed by the Center on Special Education Research for the Early Childhood Research Institute on Inclusion and have been used in previous cost studies (Odom, Hanson et al., 2001;   Odom et al., 2001).   The measures were further adapted for this project and standardized for use across the North Carolina and Indiana sites.

            Three measures were used to assess the quality of inclusive preschool programs.   The Early Childhood Environmental Rating Scale-R (ECERS-R) (Harms, Clifford, & Cryer, 1997) was used to assess the quality of the early childhood environment.    It contained subscales on Space and Furnishings, Personal Care Routines, Language-Reasoning, Activities, Interaction, Program Structure, and Staff.   Each subscale yields a rating ranging from 1 to 7, with the 4-5 rating reflecting medium program quality.   The Quality of Inclusive Experiences Measure (QIEM) (Wolery, Pauca, Brashers, & Grant, 2000) was designed to assess the quality of the inclusive experience of young children with disabilities.   The subscales for this measure used in this study were Accessibility and Adequacy of Physical Environment, Individualization, Adult-Child Contacts and Relationships, and Child-Child Contacts.   Also, The CASPER-II (Brown, Favazza, & Odom, 1995) was adapted for use in this study.   The ecobehavioral observational assessment was used to measure engagement of children with disabilities, but also provided information about the activities in which children were located, the child behaviors in which they engaged, the child-child interactions, and the adult interactions.   Three 20-minute observational samples were collected for each child.  

            To assess child outcomes, three measures were also used.   For developmental outcomes, the Battelle Developmental Inventory (BDI) was administered in the Fall and Spring of the year.   The BDI generated an overall score and also scores on the following subscales:   Personal-Social, Adaptive, Cognitive, Language/Communication, and Motor.   To assess social outcomes, the Playmates and Friends Questionnaire was completed by the classroom teachers.   This questionnaire provided information about children’s special friends.   Also, for the Indiana site, a peer rating assessment was administered in the fall and spring.   This picture sociometric assessment was completed by the typically developing children in the class and yielded a rating score that could range from 1 (does not like to play with) to 3 (likes to play with a lot).  

Results

Cost

            The mean core costs of inclusive services have been recorded in Tables 4 and 5.   Core cost refers to the cost to the public school system that has developed the Individual Educational Plan (IEP) for the child and is providing special education and related services.   The cost mainly consisted of salary for special education and related service providers, transportation for those providers, materials, and equipment.   We were not able to gather reliable information on the cost of transportation for children, the building costs (i.e., maintenance, utilities), or administrative costs.  

In previous research, Odom and colleagues found that costs of inclusion were related to the severity of children’s disabilities.   In Table 4, the program cost for children with mild disabilities were substantially different from the cost for children with moderate and severe disabilities.   Children with moderate and severe disabilities did not differ substantially in program costs.   In Table 5, the cost for the different program models have been provided.   The BP was by far the most expensive program, resulting in part because of salaries associated with the teachers, who had certification from the state.   The mean costs of the community-based programs and public school programs were very similar.   Head Start programs were the least expensive.   In these programs, the primary costs to the public schools were itinerant special education teachers who traveled to and provided services in the Head Start sites.

Quality of Inclusive Programs

            The ECERS-R was the measure that assessed the quality of the general early childhood education setting.   The overall ECERS-R rating can be found in Figure 1.   The BL programs quality from the ECERS was somewhat greater, although not statistically significantly greater, than the mean scores of the other program models.   The mean scores for the CB, HS, and PS programs were very similar.

            The QIEM subscales have been listed in Figure 2.   Each of the subscales had a different maximum rating value, indicated by the column entitled range.    Physical access was near the maximum value for all program types, indicating that all program types provided accessible environments for children with disabilities in their program.   Individualization varied across programs, with BL programs scoring higher (70 out of a possible 80 points) on individualization and the other three program models scoring similarly and lower than BL.   The adult child interaction ratings were somewhat similar across programs and near the maximum score, again suggesting that the adult-child interactions with children with disabilities was generally positive.   The child-child interaction quality was higher in the BL and CD classes than in the HS and PS classes (this difference was statistically significant), suggesting that somewhat more social integration may have been occurring in the former two types of programs.

            One indication of the quality of early childhood environments was the degree to which children have been actively engaged in classroom activities.   CASPER-II provided an observational assessment of active child participation in individual child behaviors which, when aggregated across behaviors, was a measure of overall child engagement.   As can be seen in Figure 4, children’s engagement ranged from a little over 60% of the time for children in BL to around 55% for children in the PS classes.   This level of engagement was similar to the ranges found in earlier research on child engagement in inclusive settings (Brown et al., 1999).   It indicated that as a group, children with disabilities were actively engaged in the program activities.

Child Outcomes

            Developmental outcomes were assessed by the Battelle Developmental Inventory (BDI).   The BDI Developmental Index, when displayed across the year, was an estimate of children’s rate of development, aggregated across all the subscale scores.   Across the year, the BDI-DQ changed for children from .717 to .761, indicating a positive change in the rate of development for children.   All subscale scores reflected this positive trend.   This trajectory, reflected in changes in developmental age scores on the BDI-DQ, has been demonstrated in Figure 4.   No significant differences between program types were found in changes in overall DQ or mean age equivalent scores for the subscales.   It appeared that across programs children were making progress in the programs and increasing their rate of development.

            Social outcomes were assessed by examining friendships that children developed or maintained during their school year and the changes in peers’ ratings of the children with disabilities.   The mean number of special friends for children with disabilities was .92 at the beginning of the year and 1.25 at the end of the year.   As a group, children with disabilities appeared to be maintaining and even increasing the number of special friends.   In addition, the peer ratings were very similar at the beginning and end of the year (2.10 and 2.06 respectively).   These data suggested that the peer acceptance for children with disabilities maintained across the year, even as the typically developing peers got to know them better.   Also, mean ratings of around 2.0 reflected that the children with disabilities were not socially rejected by the peer group.   Again, no program type effects were found, revealing that this finding was replicated across the four program types.

Analytic Questions

            A last question that may be asked of these data was about the relationship between the quality measures and the developmental or social outcomes for children.   An HLM analysis was conducted to examine these relationships.   The ECERS-R and the CASPER engagement measure were not associated with changes in developmental outcomes for children.   The quality of the inclusive setting was significantly associated with progress children made on several of the subdomains.   The Individualization scale of the QIEM was significantly associated with the cognitive (p < .01), communication (p < .02), and motor (p < .02) subscales.   In addition, the child-child measure of the QIEM was associated with outcomes on the BDI Motor subscale (p < .007).   No associations with the quality measures were found for the social outcome measures.

Conclusions

            Several tentative conclusions may be drawn from the findings of this study.

• Cost varies across program types, which replicated earlier research on costs of preschool inclusion.   The BL program was substantially more expensive than other programs, but it may have provided somewhat higher quality services.   Also, program cost was related to the severity of disabilities and resulting special educational needs.
• The quality of the early childhood education environments in the programs studied appeared to be medium.
• Overall, children with disabilities appeared to be actively participating in classroom activities between 55% and 60% of the time, which was similar to figures found in earlier ecobehavioral assessment research in inclusive and early childhood settings.
• As a group, children with disabilities did not appear to be socially rejected, although there was a range of peer ratings across children.
• Children with disabilities have special friendships with other children in the classes, and the number of friendships appeared to maintain or increase slightly across the year.
• The developmental quotients for children with disabilities increased across time, and child progress occurred across all domains.   These child outcomes were not related to program type.
• Individualization, as a measure of the quality of inclusion, appears to have a positive effect on child outcomes in the cognitive, communication, and motor domains.

References

Bailey, D. B., McWilliam, R. A., Buysse, V., & Wesley, P.   (1998).   Inclusion in the context of competing values in early childhood education.   Early Childhood Research Quarterly, 13, 27-47.

Brown, W. H., Favazza, P. C., & Odom, S. L.   (1995).   Code for active student participation and engagement—Revised (CASPER II): A training manual for observers.   Nashville, TN:   Vanderbilt University, Early Childhood Research Institute on Inclusion.

Brown, W. H., Odom, S. L., Li, S., Zercher, C. (1999).   Ecobehavioral assessment in early childhood programs:   A portrait of preschool inclusion.   Journal of Special Education, 33, 138-153.

Buysse, V., Wesley, P. W., Bryant, D., & Gardner, D. M.   (1999).   Quality of early childhood programs in inclusive and noninclusive settings.   Exceptional Children, 65, 301-314.

Guralnick, M. J. (1990). Social competence and early intervention. Journal of Early Intervention, 14, 3-14.

Guralnick, M. J.   (2001).   Early childhood inclusion:   Focus on change.   Baltimore:   Paul Brookes.

Harms, T., Clifford, R. M., & Cryer, D. (1998). Early Childhood Environment Rating Scale, Revised Edition.   New York:   Teachers College Press.

LaParo, K. M., Sexton, D., & Synder, P.   (1998).   Program quality characteristics in segregated and inclusive early childhood settings.   Early Childhood Research Quarterly, 13, 151-168.

Odom, S. L.   (2000).   Preschool inclusion:   What we know and where we go from here.   Topics in Early Childhood Special Education, 20, 20-27.

Odom, S. L., Hanson, M. J., Lieber, J., Marquart, J., Sandall, S., Wolery, R., Horn, E., Schwartz, E., Beckman, P., Hikido, C., & Chambers, J.   (2001).   The costs of preschool inclusion.   Topics in Early Childhood Special Education, 21, 46-55.

Odom, S. L., Horn, E. M., Marquart, J., Hanson, M. J., Wolfberg, P., Beckman, P. J., Lieber, J., Li, S., Schwartz, I., Janko, S., & Sandall, S.   (1999).   On the forms of inclusion:   Organizational context and individualized service delivery models.   Journal of Early Intervention, 22, 185-199.

Odom, S. L., Parrish, T., & Hikido, C.   (2001).   The costs of inclusion and noninclusive special education preschool programs.  Journal of Special Education Leadership, 14, 33-41.

Odom, S. L., Vitztum, J., Wolery, R., Lieber, J., Sandall, S., Hanson, M. J., Beckman, P., Schwartz, I., & Horn, E.   (2004).   Preschool inclusion in the United States:   A review of research from an ecological systems perspective.   Journal of Research in Special Educational Needs, 4(3), 17-49.

Peisner-Feinberg, E. S., & Burchinal, M.R. (1997).   Relations between preschool children’s child -care experiences and concurrent development:   The Cost, Quality, and Outcome Study.   Merrill-Palmer Quarterly, 43, 451-477.

Simeonsson, R. J., & Bailey, D. B.   (1987).   ABILITIES Index.   Unpublished assessment instrument, Chapel Hill, NC:   Frank Porter Graham Child Development Center, University of North Carolina.

Wolery, M., Pauca, T., Brashers, M., & Grant, S.   (2000).   Quality of Inclusive Experiences Measure.   Unpublished assessment instrument.   Chapel Hill, NC:   Frank Porter Graham Child Development Center, University of North Carolina.

U.S. Department of Education.   (2003). Twenty-fourth annual report to Congress on the implementation of the Individuals with Disabilities Education Act. Washington D.C.:   Author.   Retrieved April 19, 2005, from http://www.ed.gov/about/reports/annual/osep/2002/index.html.

Table 1.   Children with Disabilities in Different Program Models

Table 2.   Types of Disabilities for Child Participants

Developmental Delay = 69

Speech/Language Disorder = 34

Autism/PDD = 21

Physical Disability = 4

Mental Retardation = 3

Health Impairment = 4

Social Emotional/Behavior Disorder = 3

Visual Impairment = 3

Multiple Disabilities = 1

Hearing impairment = 1

Table 3   Measures and Time of Data Collection

Table 4.   Mean Cost by Severity of Disability

Table 5.   Cost of Preschool Inclusion by Program Type

Figure 1.   Mean ECERS-R Score Across Program Types

Figure 2. Mean QIEM Scores for Subscales

Figure 3.   Scatterplot of the BDI-DQ Age Equivalent Scores at Pretest and Posttest, plotted from the chronological age at which the pretest was given.

Figure 4.   Percentage of Observations in which Children Were Actively Engaged

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