"This is Barbara Wheeler over at Jack
and Jill Child Care Center. Look, we have a new kid in our program
this summer. His name is Sam, and he's absolutely impossible!
We know he got special services during the school year because
his mother told us, but he's making things really hard here. We
just can't have him in our program unless he gets better. Somebody
said you might be able to help us with him. I certainly hope so
because, if you can't, I'm afraid he'll have to leave. It's just
not fair to the staff or the other children to have to deal with
him every day."
This telephone call from Barbara Wheeler marked the beginning
of a 15-month consulting relationship between our program and
the Jack and Jill Child Care Center. Our program is designed to
help community early childhood programs include young children
with disabilities, but the call from Jack and Jill posed a very
different kind of challenge from those we had been facing in our
other consulting work. Our staff had been working with community
child care and preschool programs for a year, hammering out the
details, training, and making plans before actually including
children with disabilities. We had prepared programs for integration
by carefully facilitating dialogue among all of the critical "stakeholders"
in the process-parents, school district special education personnel,
community early childhood directors, and other community leaders.
In short, we had worked in the relative luxury of having time
and resources available to support planning and preparation in
what were already outstanding childhood programs.
The Jack and Jill Child Care Center was another story. This was
a program with which we had never planned. Suddenly, it was confronted
with a child who had special needs, and the staff felt entirely
unequipped to respond to this child. In addition, the program
had done little, if any, general staff training, much less any
staff training specifically related to inclusion. Moreover, the
Jack and Jill child Care Center had numerous difficulties with
many of the typically developing children they served. Finally,
the program director was clearly on the verge of excluding Sam.
Her patience and resources were already wearing thin.
Sam had been enrolled during the regular school year in a local
special education preschool. We later learned from Sam's teachers
that his mother was desperate to find summer child care that she
could afford and that would accept a child with special needs.
Sam's mother had pursued all of the obvious center-based options
as well. Her efforts, however, had been unsuccessful. The Jack
and Jill Child Center seemed to be the only remaining choice in
this small rural area.
It was clear that many things about this center would make inclusion
particularly difficult. The class sizes were very large, and many
of the staff members were inexperienced college students who usually
worked 2-hour shifts 2 or 3 days a week. Fortunately, during the
summer, the staff consisted of fewer students who worked longer
shifts. Even so, there were still about 18 staff members working
in Sam's classroom throughout the week. Barbara, the director,
made it very clear that managing the center was difficult enough
without the extra hassle of dealing with Sam.
Although we were not legally bound to provide consultation to
the Jack and Jill Child Care Center, we felt an ethical obligation
to do what we could to support the inclusion of this child. But
where should we start? This was definitely a more difficult situation
than we had encountered in our work with other child care centers.
In addition to class size and staff scheduling problems, other
issues included the long distance to the outdoor play space, the
use of an outdated curriculum, and the lack of qualified teachers.
To further complicate our work, the staff had already developed
negative attitudes about Sam's inclusion. Among ourselves, we
discussed the possibilities of an alternative placement for Sam,
but we came to the same conclusion his mother had-Jack and Jill
Child Care Center was the only choice.
We knew it was not possible to "fix" the center's problems. We
had neither the resources nor the power to make extensive changes
in the program. We had to somehow give the center's staff a sense
of their own power to solve the difficulties of including Sam,
so that they might begin to feel more competent and less overwhelmed
by their difficulties with him. One of our staff members, Monica,
was elected to take on this challenge. She began with a telephone
call to Barbara Wheeler in the hopes of gaining a clearer understanding
of the problem.
Barbara answered the telephone when Monica called. Monica
introduced herself and summarized what she had been told about
the situation with Sam before asking Barbara for more details.
"Can you tell me more about what Sam is like when he's at your
center?" asked Monica.
"All I can say is that he's really awful!" began Barbara. She
seemed to be a woman who spoke what was on her mind. "He acts
like a particularly obnoxious 2-year-old with lots of 'no's' and
temper tantrums, but he's actually 4 years old." She took a deep
breath and continued, "I don't care what other people say about
him, that kid's a lot smarter than people think he is. He knows
exactly what he's doing. He'll get what he wants one way or the
"It sounds like it's been pretty rough working with him," Monica
sympathized. Then she tried once again to get more detailed information.
"Perhaps you could tell me about the specific things he does in
the classroom that pose problems. What does he do during morning
circle, free play, lunch, or other times of the day?"
"Well, during circle he's impossible. He won't sit down. He wanders
around the room. We can't get him to sit in the circle, so sometimes
we let him just wander. When we do make him sit in the circle,
he screams and disrupts everything. We don't know if we should
expect him to sit or not. Whenever an adults asks him to do something,
he starts kicking, scratching, and butting his head into the teacher
who's with him."
"How frustrating that must be for everyone," replied Monica, "Is
there anything else?"
"Are you kidding!" exclaimed Barbara. "He causes giant hassles
around going to the bathroom. Mostly he just west in his pants.
What's frustrating is that staff will take Sam and some of the
other beginners to the bathroom at their regular scheduled times,
and Sam starts yelling and kicking and screaming, 'No, no, no!'
He'll refuse to even pull down his pants, but not 5 minutes later
he wets in his pants."
Barbara stopped her ranting and there was an uncomfortable moment
of silence. Monica didn't know whether Barbara was catching her
breath, or if the silence indicated it was Monica's turn to talk.
Even worse, Monica wasn't sure how to respond to what Barbara
just said. It sounded as through Sam had passed the point of new
return as far as Barbara was concerned. Monica was still contemplating
a response when Barbara resumed talking.
"Well, actually it was a lot worse the first week he was here,"
said Barbara. Her voice was softer and less frantic than it had
been a moment before. "Now he'll go to the bathroom without quite
as much fussing, but he still won't urinate in the toilet. He
just stand there without doing anything, and 5 minutes later he
has wet pants."
For the first time, Monica was encouraged. "It sounds like that
first week was a nightmare," she said, "but you seem to have made
some real progress with him in a short amount of time. I'm impressed!
Whatever you and your staff have decided to do seems to be working.
At least it sounds as though he's become a bit more cooperative."
"Well I guess so, but mostly I'm very frustrated," said Barbara.
"Some of my teachers say they don't like him-that he's impossible
and shouldn't be in a regular child care center. They don't have
the special skills to take are of him, and he's taking their time
away from other children." It sounded as if Barbara wasn't the
only one was exasperated by Sam's behavior.
"What really infuriates me," continued Barbara, "is that his mother
didn't tell us how bad he was. If things don't get better soon
we're going to have to tell her we can't have him in our program.
Really, you should see how it is in the classroom! It's not fair
to the staff or to the other children."
"I can appreciate how frustrating this must be for you and your
staff," replied Monica. "He sounds like a real handful, but it
also sounds as though you've had some success in dealing with
him. I'm glad you called us because we'd certainly like to support
you in trying to make this work."
"We have fewer children here in the summer, so we are willing
to give it another try. But the fall is another story," cautioned
Barbara. "He'll have to improve a lot if he's going to stay in
our program then."
"I see," said Monica. "Well, perhaps I could visit the classroom
and then recommend how we might work together. Could I come and
watch him in the classroom and then meet with you afterward?"
"That sounds good," answered Barbara. "Could you come tomorrow?"
It seemed important to be responsive at this point, so Monica
rescheduled the meeting she was supposed to have with her supervisor
the next morning. She would go to the center to observe Sam and
Although not quite the terror that was described over the telephone
the day before, Monica could see that Sam was indeed a difficult
child to manage. As she suspected, Monica noted that the staff
were inconsistent in how they dealt with Sam and having different
staff members in charge throughout the morning only aggravated
the problem. Sam seemed to try out each new person who entered
the room only to get a different response from each of them. The
only consistent management of Sam was during toileting. Although
the staff had taken a rather strong-armed approach with him in
the matter of going to the bathroom, it was consistent.
Soon after lunch, the children went outside to play, and Monica
met briefly with Barbara Wheeler and one of the lead teachers,
Rita. Monica went over the notes she had taken and summarized
her observations in terms of the inconsistencies in staff responses
to Sam's behavior. Barbara and Rita acknowledged the inconsistencies
that Monica described and agreed that it probably contributed
to their difficulties in managing Sam's behavior. They talked
further about how difficult it would be to ensure that everyone
responded to Sam in the same way because there were so many staff
members involved and their schedules were so varied. Nevertheless,
Barbara made it clear that the number of staff members and their
schedules were aspects of the program that could not be changed
to accommodate Sam.
Barbara and Rita discussed ways they had tried to communicate
with the large staff on other issues and described their frustration
with their previous methods. Even so, Monica asked if they could
think of any ideas for improving communication among the staff
in deciding on and implementing methods for handling Sam. After
much discussion about the difficulties of getting the whole group
together, Barbara and Rita decided they would try to assemble
the entire staff for a meeting. This had never been done before.
Their hope was to come to an agreement on a plan and carry it
out consistently. When Barbara asked, Monica agreed to facilitate
Before leaving the center that day, the three women worked out
a plan for the meeting so Barbara could better explain to the
staff why she was asking them to get together. First, everyone
would discuss the problems in handling Sam and decide what needed
to be attended to first. They would also share the various methods
everyone had tried with Sam and how well they had worked in controlling
his behavior The group would then decide on strategies for everyone
to follow in responding to Sam's specific problem behaviors. Finally,
the group would decide how to monitor its progress and maintain
consistency in responding to Sam.
Monica suggested that Sam's mother might be included in the meeting,
but this idea was met with resistance. Barbara and Rita agreed
that consistency between home and child care was important, but
they said that Sam's mother was not very cooperative. Furthermore,
they thought the staff would be uncomfortable with her presence
at the meeting. Monica was not pleased with their attitude toward
Sam's mother, but kept her feelings to herself. If the staff could
experience some success in changing Sam's behavior at the center,
they might feel more confident and consequently be more willing
to involve Sam's mother in the future.
In discussing who else should be included in the meeting, Barbara
and Rita mentioned that it would be helpful if they knew how Sam's
previous teacher had handled him in the classroom. Barbara talked
about where he had been enrolled and Monica realized that his
previous teacher must have been a woman named Rhonda, whom she
had met on several occasions through her work on an interagency
committee. Although Rhonda would be on summer vacation now, Monica
offered to try to call her at home and see if she would
be willing to come to a meeting about Sam.
is the Problem?
The meeting was held on a Tuesday evening after the center closed
and, of the 20 people invited to the meeting, 15 attended. Monica
had succeeded in contacting Rhonda, and she was among those who
attended. Following a brief introduction by Barbara, Monica opened
the meeting. She began by saying how impressed she was with the
group's dedication, as demonstrated by their willingness to get
together in the evening to talk about Sam. She also talked about
the positive things she had seen during her recent observation
in the child care center, emphasizing their successful beginning
in overcoming Sam's resistance to toileting. Then Monica outlined
the purpose of the meeting and opened the floor to a general discussion
of the problems they were experiencing with Sam and strategies
for dealing with his misbehavior. For an hour and a half, the
group engaged in animated storytelling of their experiences with
Sam and lively discusssion about what needed to be done.
"Well, the hardest thing for me to handle is Sam's yelling, flailing
his arms around, and hitting me when I ask him to do something,"
said one of the child care workers. "It's so frustrating! It's
gotten to the point where I try to avoid asking him to do anything-but
sometimes I just have to."
"I think those spells are the hardest thing for a lot of us,"
agreed Rita. "They seem so out of proportion to what he's been
asked to do. It's especially bad when it's time to go to the bathroom
or to the kitchen to eat."
"Yeah," someone else chimed in, "I hate it when he has a fit about
going to the bathroom."
"Well, how about when he's in the bathroom?" interjected a male
college student. "It takes him forever, so he's usually late going
to lunch. Then he's late finishing lunch and."
"That's a problem," said another student, "because the confusion
of other kids finishing and putting their dishes away distracts
Sam, and he ends up barely eating anything."
"And I'm irritated that with the problems at lunch time you can
almost count on him wetting his pants even though you've just
taken him to the bathroom," Rita added, rolling her eyes in exasperation.
"I just hate it when he starts yelling," said a small voice from
the back of the room. The woman, a student, couldn't have been
more than 17 or 18 years old. "He yells when I take him to the
bathroom, he yells at lunch, and he yells when it's time to go
outside. He had a real tantrum one day when I told him it was
time to go to circle." She paused a moment and scanned the room
for indications of agreement. "Now I just let him do what he wants
during circle. Sometimes he comes on his own and sometimes he
"And if he comes to circle," said someone else, "he usually only
stays a minute or two. Then he goes wandering off. Of course,
then the other kids want to wander, too."
"I'm not sure what to do with circle either," added another student.
"I tend to just let him do what he wants, too.Believe me, I regret
it if I don't!"
At this point, Monica felt that enough time had been devoted to
descriptions of Sam's misbehavior and staff members had had adequate
opportunity to vent their frustration. She wanted to help them
clarify and focus the problem. She asked whether others had found
that Sam became upset when he was asked to move to a new activity.
Everyone agreed that he seemed to be set off by transitions.
"Are there any other kinds of concerns you have about these situations?"
"Well, one of the things I find to be difficult," began one of
the workers, "is that whenever there is a transition, but particularly
with the big transition, he doesn't do the appropriate thing.
For instance, he might go into the pantry instead of the free
play area after snack."
Another worker nodded her head and said, "I've seen that a lot.
For instance, on his first day here, when we were walking to the
playground, he started wandering upstairs."
"Yeah," agreed a student, "it doesn't seem like he's deliberately
trying to disobey the plan-he just wanders off."
"I've seen that too," said another, "and it makes me worry that
he could easily get himself into a dangerous situation. It makes
it more difficult to have him in the group because I have to to
pay attention to him every second. Sometimes it seems like it
isn't fair to the other kids."
Rhonda, who had not said a word up to this point, finally spoke,
"We see that same wandering off in our preschool," she said. "We
take turns being the one responsible for keeping close tabs on
what he's doing. We list whose turn it is on the daily schedule
and we try to make sure he knows the routine."
"That's a good idea," said someone.
"That does sound like a good way to relieve the pressure," said
Monica. "Have any of the rest of you seen this behavior of wandering
off during transitions?" Her question was met with vigorous head
nodding and murmurs of affirmation among the group. This did,
indeed, seem to be one of the major difficulties in working with
Sam. Monica thought she would check out other issues. "Are there
any other concerns?" she asked.
The young woman in the back of the room spoke again. "I just feel
uncertain with Sam. Sometimes I expect the same things I do of
the other children and he does well. Other times I expect the
same and it's totally unrealistic for him."
Two other group members agreed. They didn't know what was fair
to expect of Sam either.
"Well, we've been working with him for a year now," said Rhonda.
"Maybe we could share some of our experiences and testing results."
"That would be very helpful," said Rita.
"Yes, that would be helpful," said Monica. "Let's talk about those
strategies as soon as we finish identifying what we think the
major issues are, okay? Are the rest of you also uncertain of
what is reasonable to expect of Sam?" Again, there was vigorous
nodding from the group. Another major issue had been identified.
"Are there any other concerns?" asked Monica.
Barbara, who had been looking at her watch with increasing frequency
during the past 20 minutes, spoke up. "I think we have other problems,"
she said, "but some of them are related to the ones we've already
talked about. I think we should figure out some strategies to
deal with these first and deal with the others later."
Following Barbara's lead, Monica summarized the concerns the staff
had identified: 1) Sam often yells, screams, scratches, and hits
when he's asked to change activities, particularly at major transition
times; 2) Sam often wanders into an inappropriate activity during
transition times, particularly when going to and from meals and
the bathroom; and 3) staff are uncertain about the level of behavior
they should expect of Sam. The group agreed that these were the
major concerns, and Monica turned the discussion in the direction
of developing a plan of action.
Plan of Action
Monica began by having the group discuss strategies they had tried
and had seemed to hold some promise for the future. The group
members discussed some of their successes in working with Sam.
Individuals often identified things that few in the group had
tried or known about. Approaches that had helped for two or more
care providers included:
- When Sam
was informed ahead of time about transitions and had some direct
assistance, he seemed to have somewhat fewer outbreaks of screaming.
- If Sam
was taken to a quiet place when he was screaming, kicking, and
flailing, he often calmed down and could do the proposed activity
- When Sam
sat near an adult during circle time, he seemed to attend somewhat
longer in circle.
Sam responded to a direct contingency statement such as, "You
can go to the water table after you eat one bite."
- When Sam's
behavior was dealt with in the same way across days and among
all staff members, he seemed to eventually catch on to the rules.
- When Sam
was chosen to be one of the first children to do an activity,
he did better than when he had to wait.
Everyone agreed that it was important to establish a plan and
be consistent in following through with it. Each of the major
problems that had been identified were listed on a small chalkboard
and ideas were generated for dealing with each. Although Monica
facilitated the discussion and helped the group to clarify its
decisions, only ideas developed by the staff were included in
the plan of action. At the close of the meeting, Monica agreed
to write up the plan of action that they had developed.
Barbara Wheeler and her staff left the meeting feeling good about
the plan they had developed. Several staff members commented that
it felt good just to talk about the things with which they had
been struggling. Others said that it felt good to know how they
would respond to Sam, even if their strategies proved unsuccessful.
Sam remained enrolled in the center for the next 15 months. The
initial plan of action was not completely successful, but Sam
did show clear progress in several areas. His screaming almost
entirely disappeared, and the cues staff used at transition times
greatly reduced his wandering. Monica monitored Sam's progress
and took care to reflect his gains back to the staff. The staff
began to take real pride in what they had accomplished with Sam.
During the next few months, Monica facilitated three more meetings,
and Barbara and her staff began to view getting together to clarify
problems, share ideas, and plan a common "approach" as a strategy
they could use to address other problems at the center. As they
began to say things like, "maybe we need to get together to deal
with this," Monica knew her major goal had been attained.
All of the problems at the Jack and Jill Child Care Center were
not resolved. Barbara faced a continuing dilemma about the time
and expense of calling staff meetings, and therefore meetings
were often delayed until problems reached crisis proportions.
Several of the behavior problems staff saw with Sam were never
completely resolved. For example, he never did sit very well during
circle time. Nevertheless, Barbara Wheeler and the staff became
more aware of their own capacity to sole problems related to including
children with special needs in their program-and Sam's mother
maintained the child care she so badly needed.
OF ACTION FOR SAM
to Circle Time
Sam will come to circle, sit down, and initially stay for
3 - 4 minutes. Depending on his progress, each week he will stay
for a longer period of time, up to the full time of circle (10
-15 minutes). If the circle time is more lengthy, he will be permitted
to move to free play as the younger children are.
- The head
teacher will alert Sam once, prior to the start of circle, that
circle is about to begin. She will assist Sam in cleaning up
or finishing his activity. She will tell him personally when
it is time to come to circle, take his hand, and walk him to
- A designated
adult will sit near Sam and remind him of the rule: "We all
stay in circle until it's time for _________."
- If Sam
begins to scream, kick, or otherwise act out, the designated
adult will take him to the book corner on the other side of
the room and explain that he cannot return to the group until
he has quieted. The adult will then turn away from Sam, but
Sam will wash
his hands and urinate at the times that the group does, and he
will leave the bathroom at the appropriate times.
- The first
adult leaving circle with a group going to the bathroom will
ask Sam to join his or her group and take his hand to walk with
- This adult
will be very matter-of-fact. If Sam doesn't do the expected
actions once in the bathroom, the adult will give him cues about
appropriate behavior such as, "Sam, what do you do first?",
"Remember, you need to wash your hands next, Sam," and so forth.
- If Sam
urinates in his pants, the adult will encourage him to try to
urinate again in the toilet before assisting him in changing
- When Sam
is finished using the bathroom, the same adult will ask him,
"Where do you go next, Sam?" He or she will monitor Sam as he
leaves the bathroom, will assist him in finding a seat at the
snack table, and will sit at his table and ensure that he begins
eating, in the same way he or she handled the bathroom routine.
Level of Behavior to Expect of Sam
staff will be more aware of Sam's capabilities and what is reasonable
to expect of him in daily routines.
- Sam's special
education teacher, Rhonda, will come to a staff meeting next
week and describe what she believes are reasonable expectations
of Sam based on her testing and experience with him.
will also bring a written sheet she has developed for her staff,
listing what Sam can do, and what he's working to accomplish.
will observe Sam and the staff three times weekly for 20 minutes
during the next 3 weeks. She will focus her observations on
the expectations and approaches identified by the group.
- Staff members
will report directly to Barbara to inform her of any difficulties
they may be having in following through with the plan of action,
and whether they are seeing any changes in Sam's behavior.
will meet with Barbara and Rita once a week to report her observations
and to discuss the staff's experiences and Sam's progress. If
necessary, this group will suggest possible modifications of
will meet with the entire staff in 1 month to discuss progress
and make modifications in the plan.
This case story originally appeared in McWilliam, P.J., &
Bailey, D., (Eds.). Working Together with Children & Families,
Case Studies in Early Intervention. (1993). Baltimore: Paul H.
Brookes Publishing Co.
and Jill--and Sam?