AIMHiTN Inclusion Support Form

AIMHiTN Inclusion Support Form

Thank you for partnering with us at AIMHITN! Our hope is to support you and your agency in the best way possible to enhance the lives of children ages 0-6. As you answer the questions below, please think of ways AIMHITN can help not only your staff but also your programs be more inclusive of children with disabilities. Inclusion can be defined asWe are here to be a resource for encouraging dialogue, promoting accessibility, providing policy updates, conducting trainings, and celebrating diversity. Our goal is to create support that encourages continuous improvement in assessing the effectiveness of inclusion support and making adjustments to enhance its impact.We look forward to collaborating with you to ensure that all children and caregivers feel known and seen. For more information or questions, contact our Inclusion Advisor Rion Humphries, MSW at RionH@aimhitn.org
Name*

First NameLast Name
Which County do you work in?*
How many years of experience do you have in early childcare?*
What sector do you belong to?*
Are you AIMHiTN Endorsed? If so what level of endorsement do you have?*
Which of the following best describes your racial or ethnic background?Please select all that apply.*

WhiteBlack or African-AmericanAsianHispanic or LatinxNative American or IndigenousPacific IslanderOther
What is the primary language you speak?*
Do you serve children ages 0-6 with differing or special needs?*
Do you feel comfortable communicating with families when you have concerns that a child may have a disability or special need? *
Do you currently, or have you in the past, served any children ages 0-6 who you felt had special needs but did not have a diagnosis?*
Can your program meet the needs of the children requiring the following accomodations?*

MobilityEatingNeurologicalSocialBehavioralToiletingMedicationsSeizuresAsthmaAllergiesVision DifferencesHearing DifferencesOther
Who do you rely on most for information on how to best care for children with differing needs?*
Which of the following present the greatest difficulty in accepting and caring for children with differing needs?*

Behavioral IssuesPhysical Medical IssuesNever Served a Child with Differing NeedsLack of Education on How to Serve Children with Differing Needs
Has your center ever had to deny enrollment due to a lack of accomodation? Have you ever had to ask a family to find an alternative referral?*
What are the most challenging barriers in appropriately and effectively accommodating children with different abilities?*

Not Enough StaffDifficulties Including Children with Differing Abilities in Daily ActivitiesDisruptions to ClassroomLack of TrainingAdministering Medications
What are the benefits to including children with differing needs in your program?*

Seeing Children Overcome ChallengesLearning About DisabilitiesOffering All Children a Chance to Learn About DifferencesEncouraging and Supporting FamiliesOther
What additional training or resources would you like regarding working with children with disabilities?*

Navigating Difficult Conversations with CaregiversBehavioral IssuesDisability Specific TrainingInclusion in General
How would you rate the inclusivity of your organization on a scale of 1 to 5?*

1

2

3

4

5

1 is Worst, 5 is Best
What barriers have you encountered in incorporating inclusive practices into your work*
How comfortable do you feel asking questions about ability? Are these questions being asked to families, children, leaders, etc?*
How satisfied are you with the accessibility of your organization for parents of children with disabilities?*

1

2

3

4

5

1 is Very Dissastisfied, 5 is Very Satisfied
What resources or training regarding inclusion and supporting children with diverse needs have you received?*
Are you currently engaged with an inclusion coach, such as CCR&R or an external consulting agency? If not, would you be interested in connecting with one?*
What kinds of training do you believe would be beneficial for your agency regarding inclusion?*
For training requests, contact Rion Humphries at rionh@aimhitn.org.
Are you familiar with our Belonging Awards, which recognizes and encourages inclusive spaces, and assists agencies to engage in conversations about the best inclusive practices? Would you be interested in donating or applying for the awards?*
For more information visit our website.
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