Finding Child Care for Kids with Extra Support Needs

If your child receives services from a state disability agency, such as Regional Center in California, then respite hours for parents may be an available service. Talk to your child's case manager or service coordinator about how to access respite.

Respite may also be a covered service under your insurance plan if your child qualifies for state Medicaid.

Your case worker or your insurance might direct you to respite care agencies that can help you find a respite worker. Here’s what you need to know:

• Agency respite workers are typically paid minimum wage and bound to an in-home only service. If you need care outside your home, you may ask for an exemption.
• If your child has a specialized medical condition, it’s important to find out what type of intervention is allowed by the respite worker. For example, some agencies require respite workers to have licensed vocational nurse (LVN) training to be allowed to change a G-tube or intervene during a seizure. Others dictate that their respite workers cannot practice these interventions while some allow parents to train workers in this area.
• Remember that if you don’t find a respite care worker to be a good fit, you can request different care providers.

Some organizations that fund respite allow parents to find their own caregiver. Lisa Carey suggests that parents “go about this the same way they would finding a babysitter. They can use their family members, friends, parents’ groups on social media, or real-life connections.” Carey adds that she prefers parent choice over agency-assigned as it allows the parents to be in more of a supervisor role, dictating what respite care workers can and cannot do.

If you find respite services inadequate for your needs, you can look for a private agency to help you hire a child care provider, or you can screen for a provider yourself on a job board site. Here are some potential nationwide resources:

• Nanny League
• Care.com
• Sittercity
• UrbanSitter

Truly Care is also launching in Los Angeles and will expand to more cities, so check the website to join the waitlist and check for updates.

Note that each agency or site has its own requirements for who is qualified to provide care, the costs, the background check and matching process, and experience providing care to children with disabilities, so you will need to do your research as far as the best fit for your family. You can also ask the Undivided Research Team for help narrowing down your options.

• You can look at colleges in your area that offer programs to prepare students to work with children with disabilities, such as autism-centered studies, special education, or ASL.
• Some colleges have job boards where you can post listings to hire nannies, sitters, and tutors, such as Handshake. We’ve heard that Undivided parents have also found good candidates using Indeed.com. When you post an ad, let potential candidates know that they will have to go through a background check.
• You may want to ask your child’s therapy providers and school team for referrals for in-home care services.

If your household has low income, you may be eligible for subsidized child care from programs. Check out these resources from the Child Care Resource Center to learn about the options and eligibility criteria.

Even if you’re going through an agency, it’s helpful to have a list of questions to ask a caregiver to help you find the right fit and set expectations for their responsibilities. One parent recommends setting up a list of “must-haves, flexible-to-haves, and nice-to-haves” that you can reference as you interview a candidate.

Think about your child’s specific needs as you come up with questions to ask during a phone and/or in-person interview. Here are some general ideas to get you started:

• What are your qualifications? What areas of training or certification have you received?
• What experience do you have caring for children with extra support needs [or your child’s specific disability]?
• How familiar are you with [medical equipment or other assistive tech, such as AAC your child uses]?
• How comfortable would you be helping my child with [toileting, dressing, mealtimes, other important needs]?
• Can you tell me about a time you handled a particularly challenging behavior or medical need?
• Can you tell me about a time you had to navigate something unexpected in a caregiving role?
• What is your process for documenting your caregiving activities and progress reports?
• What would be your process for building a trusting relationship with my child?
• What questions do you have for me?

Bohn recommends asking, “What are your aspirations in life? What are you excited about? What are you passionate about?” She says, “When you're working with a child or an adult with a disability, generally, there has to be some connection to why you're seeking a job like that. There's nothing wrong with saying, ‘I need extra cash, and this is a side hustle for me,’ but that may not necessarily be enough to get through some of the behavioral challenges, scary moments, or frustrating moments that inevitably come. Getting a deeper understanding of what connects them to this opportunity or to this line of work is the best question to start with, and it gives you an immediate sense of where this person is coming from and what they're looking for. Because at the end of the day, if they're not getting what they're looking for, it will start to feel like a poor match.”

Bohn says that finding a candidate who’s a good match is incredibly important so that you’re not back to the drawing board every few months finding a new provider.

How to run a background check

Most agencies and some sitter websites will take care of the background check as part of their service, but if you’re hiring a provider yourself, you may want to run a background check before committing to your preferred candidate.

In California, background checks that assess criminal or credit history for employers are regulated by the Fair Credit Reporting Act. As a potential employer, you must obtain written consent from the candidate before you run the background check.

You can manually check public records, or you can use a third-party service such as Checkr, BeenVerified, or eVerify to process the background check for you for a fee. Some aspects that a background check can verify include:

• Identity
• Eligibility to work in the United States
• Criminal history
• Sex offender registry entry
• Driving records

Bohn says, “When you bring someone new in, and I've been there many, many times, you wish you could just hit the fast forward button, and they knew everything they need to know, they’re already bonded with your child, and everything is just good, but that's just not reality. And so I like to think of onboarding as a scaffolding project.” Here are her tips for gradually onboarding a new child care provider in your home:

1. Make sure the caregiver has time to bond with the person they're caring for and establish trust. This may take a couple of sessions.
2. New caregivers can be intimidated by parents, so if possible, let another caregiver take the main role in training your new provider.
3. Show the new caregiver your household’s full routine while they take notes so that they understand all their responsibilities up front. Then, have them perform the tasks under supervision.

Ideally, Bohn says, “within three to five sessions being in the house, they are ready to be on their own, and they are fully comfortable with the routine and the preferences and the nuances of your child.” By avoiding just throwing a new care provider into the deep end, you can help prevent “a bad situation where the care provider feels unsupported and may make decisions that are not safe or smart for your child.”

We know it can seem daunting to find a child care provider who will meet your kid’s needs when you’re not available, but we hope these resources will be helpful in finding a great fit for your family. You can also check out our article on in-home nursing for tips on introducing a new caregiver to your household and routine, managing expectations, and more.