Educacion temprana, especial inclusión. unicef

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Educacion temprana, especial inclusión. unicef

  1. 1. EMILY VARGAS-BARÓN & ULF JANSONwith NATALIA MUFELEARLY CHILDHOOD INTERVENTION,SPECIAL EDUCATION AND INCLUSIONFOCUS ON BELARUS
  2. 2. UNICEF Regional Office for CEE/CIS Emily Vargas-Barón & Ulf Janson with Natalia Mufel Early Childhood Intervention,Special Education and Inclusion: A Focus on Belarus Minsk «Altiora – Live Colours» 2009 I
  3. 3. UDC 376.1(476)(047.1) Emily Vargas-Barón Director The RISE Institute Washington, DC, USA E-Mail: vargasbaron@hotmail.com Ulf Janson Professor Department of Education Stockholm University, Sweden E-Mail: janson@ped.su.se Natalia Mufel Early Childhood Development Specialist at UNICEF – Belarus Country Office E-Mail: nmufel@unicef.org currently – UNICEF, Cambodia For further information, please contact: Deepa Grover Regional Advisor Early Childhood Development UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States E-Mail: degrover@unicef.org The opinions expressed in this document do not necessarily reflect the policies or views of the United Nations Children’s Fund. The designations employed and the presentation of the material (including maps) do not imply on the part of UNICEF the expression of any opinion whatsoever concerning the legal status of any country or territory, or of its authorities or the delimitations of its frontiers. Photographs: Alexander Konotop Typeset and layout: Dzianis Puhach Proof reader: Dzianis Stulov ISBN 978-985-6831-35-8 © Unicef, Regional office for CEE/CIS, 2009II
  4. 4. The Project on child development, preschool and school inclusion, and support to childrenThis study reviews early childhood with special needs and their families. He is aintervention (ECI), special education and scientific counsellor to the National Board forinclusive education programmes in Belarus. Social Affairs, Sweden, on issues of childhoodUpon the request of UNICEF’s Regional Office disability, member of the Coordinatingfor CEE/CIS, it presents key programme Committee of International Society for Earlyconcepts and information, identifies lessons Intervention (ISEI), and member of the EU- andlearned, offers recommendations, and FIPSE-sponsored Transatlantic Consortium forpresents general Guidelines for ECI and Special Early Intervention. He has been a counsellorEducation Systems for the consideration of to the International Step-by-Step Associationother countries in the region and the world. (ISSA) and he collaborates with the Department of Psychology at St. PetersburgThe Authors State University and the Early Intervention Institute, St. Petersburg, in research andEmily Vargas-Barón directs the Institute for development of preschool inclusion.Reconstruction and International Security Publications in non-Scandinavian languagesthrough Education (The RISE Institute), include, except for scientific articles andWashington, D.C. and Bogotá, Colombia. reports, contributions to Brambring & RauhShe conducts research projects, advisory (Eds): Early Childhood Intervention, Research,services and training in integrated ECD and Theory and Practice (1995) and Kreuzer &education. From 1994 to 2001, she was a Ytterhus (Eds): Dabei sein ist nicht alles. SozialeUSAID Deputy Assistant Administrator and Inklusion und Marginalisierung in integrativendirected USAID’s Center for Human Capacity Gruppen der Kindertagesstätte (in press).Development. Previously, she foundedand directed the Center for Development, Natalia Mufel received her diploma inEducation and Nutrition (CEDEN, now called Psychology from the European Humanities“Any Baby Can”), an ECI and ECD programme University in the Republic of Belarus. Herserving families living in poverty in the U.S. studies include: postgraduate courses inShe also served as an Education Advisor for Belarusian State University (Psychology);The Ford Foundation’s Andean Region and as Belarusian Post Diploma Medical Academya UNESCO Education Specialist. She has been (Psychotherapy of Children and Adolescents);a professor at the University of Washington, Eastern-European Gestalt-Institute; andUniversity of Texas, Javeriana University, and Moscow Institute of Psychotherapy. She hasSorbonne University. She holds a Ph.D. in experience as a researcher, psychologist,Anthropology from Stanford University. She and lecturer in psychology, gender, childis the author of many books and articles, development, reproductive health, familyincluding: Formative Evaluation of Parenting psychotherapy, and PTSD/crisis interventions.Programmes in Four Countries of the CEE/CIS She has worked with working severalRegion: Belarus, Bosnia & Herzegovina, Georgia multilateral, NGOs and governmentaland Kazakhstan, (2006 UNICEF) and Planning agencies. In UNICEF’s Belarus Office, she wasPolicies for Early Childhood Development: the ECD Specialist and Focal Point for Health,Guidelines for Action, published in English, Nutrition, Gender, Pre-school Education,French, Spanish and Russian (2005 UNICEF, Stress Management, P2D and MICS3. NataliaUNESCO and ADEA). is currently working as ECD Specialist in UNICEF’s Cambodia Country Office.Ulf Janson is a professor in Education atStockholm University, Sweden. He holds aPh.D. in Educational Psychology (Pedagogics)from that university. He conducts research III
  5. 5. Dedicationand AcknowledgementsThis publication is We are grateful to Branislav Jekic, UNICEF • Larisa Nikolaevna Bogdanovich,dedicated to the Representative for Belarus, and to Natalia Chief Physician, Brest Regional Medical Mufel, UNICEF Early Childhood Development Rehabilitation Centre “Tonus” forchildren of Belarus Specialist, who arranged our site visits in children with psycho-neurologicaland to the Belarusian Belarus and St. Petersburg and contributed diseasesspecialists who help extensive information for this study. We • Tatyana Zhuk, Director, Brest Regionalthem achieve their also thank Deepa Grover, UNICEF Regional Developmental Centre of Specialpotential. Adviser for Early Childhood Development, Education who initiated this study, shared many • Irina Evgenievna Valitova, resources, and joined us in St. Petersburg. Head, Developmental Psychology Department of the Brest State Special gratitude to these leading Belarusian University and Russian professionals for their generous • Iryna Romualdovna Rumyanceva, help: Director, Kobrin Development Center of Special Education, “Alpha” • Galina Vladimirovna Molchanova, • Ludmila Mihailovna Sheveleva, Director of the Minsk Development Acting Chief Physician, Kobrin Centre for Special Education, in Children’s Polyclinic Correction and Development Training • Maria Ivanovna Samcevich, Head, and Rehabilitation Centre Medical Rehabilitation Department of • Victoria Vitalievna Troinich, Principal the Kobrin Children’s Polyclinic Inspector of the Special Education • Tatyana Fedorovna Avdeichuk, Chief Department of the Ministry of Physician, Brest Children’s Polyclinic #1 Education, Belarus • Oksana Evgenievna Trofimuk, • Alexander Nikolaevich Yakovlev, Director, Development Center of Chief Physician of the Minsk Medical Special Education “Veda”, Moskovskii Rehabilitation Centre for children with District of Brest psycho-neurological diseases • Elena V. Kozhevnikova, Director, St. • Svetlana Mihailovna Eremeiceva, Petersburg Early Intervention Institute Head of the Psychological Department • Natalia U. Baranova, Deputy Director of the Minsk Children-Adolescents in Education, St. Petersburg Early Psycho-neurological Dispensary, Chief Intervention Institute Psychologist of the Minsk Health Executive Committee Our warm thanks also to Sarah Klaus (OSF, • Elena Titova, Chair of the non- London, UK), Elena Kozhevnikova (EII, St. governmental organisation Belarusian Petersburg, Russian Federation), Deepa Association of Assistance to Children Grover, Jean Claude Legrand and Severine and Young People with Disabilities Jacomy Vite (UNICEF, RO CEE/CIS), for their • Olga Grigoirievna Avila, Chief, Early thoughtful comments and enriching inputs Intervention Centre in Minsk’s 19th that helped immensely to give final shape to Polyclinic this document. • Iryna Mihailovna Voitsehovich, Speech Therapist, Early Intervention Centre, 19th Polyclinic • Oktyabrina Veniaminovna Doronina, Psychologist, Early Intervention Centre, 19th Polyclinic • Alina Anatolievna Nichkasova, Psychologist, Early Intervention Centre, 19th PolyclinicIV
  6. 6. Table of ContentsDedication and Acknowledgements .......................................................................IVTable of Contents .......................................................................................................VPreface.......................................................................................................................VIIExecutive Summary ............................................................................................... VIIIPart I: Introduction .................................................................................................... 1I.1 Early Childhood Intervention: an essential part of all early childhood systems ..................................................................................................... 3I.2 Objectives, limitations and scope of the study....................................................................... 4Part II: Definitions, Conceptual Approaches and Context....................................... 5II.1 General definitions and approaches to ECI............................................................................. 8 II.1.1 Child status..................................................................................................................... 8 II.1.2 Special education needs.............................................................................................. 8 II.1.3 Early childhood intervention...................................................................................... 9II.2 Children with developmental delays or disabilities...........................................................10 II.2.1 Global rates of developmental delay and disability...........................................10 II.2.2 Services for children with special needs in CEE/CIS Region..............................11 II.2.3 Delay and disability in Belarus.................................................................................13II.3 Continuum of early childhood services.................................................................................15II.4 Defectology and special education.........................................................................................16II.5 Inclusion issues...............................................................................................................................19II.6 Continua regarding conceptual approaches to ECI...........................................................22Part III: The Belarusian Support System for Families with Special Needs Children....................................................................... 25III.1 Overview of the system for ECI, special and inclusive education................................27III.2 Introduction to health, medical and education services................................................30III.3 Polyclinic-based Early Childhood Intervention Centres..................................................32 III.3.1 ECI Centre at Polyclinic 19, Minsk...........................................................................32 III.3.2 Polyclinic ECI Centre, Kobrin....................................................................................34III.4 Child and Adolescent Psycho-neurological Dispensaries..............................................37 III.4.1 Psycho-neurological Dispensary, Minsk...............................................................37III.5 Medical Rehabilitation Centres, MOH....................................................................................39 III.5.1 Medical Rehabilitation Centre, Minsk...................................................................39 III.5.2 Medical Rehabilitation Centre, Brest’s “Tonus Centre”......................................39III.6 Development Centres, MOE......................................................................................................42 III.6.1 Development Centre, Minsk....................................................................................43 III.6.2 Development Centre, Kobrin’s Alpha Centre.......................................................44 III.6.3 Development Centre, Brest......................................................................................45III.7 Infant Homes..................................................................................................................................47III.8 Preschools for children with special needs, MOE..............................................................49III.9 Belarusian Association of Assistance to Children and Young People with Disabilities.................................................................................................52 V
  7. 7. Part IV: Lessons from Belarus and Recommendations.......................................... 55 IV.1 Main triggers and drivers of the ECI and Special Education System..........................57 IV.2 Lessons learned and recommendations for Belarus........................................................59 IV.3 Recommendations for training, exchange and networking.........................................66 Part V: Guidelines for Establishing ECI Services .................................................... 69 V.1 Introduction.....................................................................................................................................71 V.2 ECI Guidelines..................................................................................................................................72 V.2.1 Basic principles............................................................................................................72 V.2.2 Range of services.........................................................................................................72 V.3 Guidelines Chart.............................................................................................................................74 Bibliography............................................................................................................................................79 Annexes..................................................................................................................... 85 Annex I List of Acronyms..........................................................................................................85 Annex II Official Belarusian ECI Documents: Main Inter-agency Agreements, Regulations and Guidelines.........................................................86 Annex III Map of the Republic of Belarus and Main Indicators and Locations Visited by the Researchers..................................................................87VI
  8. 8. PrefaceVulnerable children require early are presented in Part V. We look forwardchildhood development (ECD) services to receiving your comments on theseto help them achieve their potential. suggestions.However, ECD programmes in manyworld areas aimed at serving vulnerable Because this review deals with manychildren tend to be short in duration complex and sensitive issues, UNICEF feltand they have general contents that are it was appropriate to create a two-personmore appropriate for typically developing study team that united our experienceschildren. Abundant research has shown with ECD and ECI systems in Europe,that effective services for vulnerable, high- Russia, Eastern Europe, the United Statesrisk, developmentally delayed or disabled and Latin America. With respect tochildren should be more intensive, study methodology, we conducted anenriched and longer in duration. extensive desk review of many studies and documents, systematic observationsProviding intensive and enriched of programme services in action whereverservices for vulnerable young children possible, and probing interviews ofis sometimes considered to be overly many parents, programme directors andexpensive. After significant experience, personnel. We crosschecked informationwe believe this to be untrue. New types extensively with a variety of sources toof Early Childhood Intervention (ECI) ensure the greatest accuracy possible.programmes for vulnerable children UNICEF personnel, and most especiallycan be designed with varying levels of Natalia Mufel, provided extensiveintensity and richer curricula, learning information about the evolving ECImaterials and methods. In addition, system in Belarus.better community outreach and childassessment systems are needed to On a personal level, it was very rewardingidentify children with high-risk status, to work together and share ideas. Wedevelopmental delays, malnutrition or hope our readers will agree.disabilities. Improved and expandedpre- and in-service staff training and Emily Vargas-Baróncombined supervisory, monitoring and Ulf Jansonand evaluation systems are required tosupport programme development overtime.As we shall show in this study,investments in ECI, special educationand rehabilitation services are lesscostly than institutionalising children,and in addition, they are far morehumane, effective, child-centred andfamily-focused.Because most countries in the CEE/CISregion have large health and educationsystems, we believe they are poisedto develop ECI, special education andinclusive preschool services. To enter thisnext stage of programme developmentfor young children, we encouragereaders to review the initial Guidelinesfor Early Childhood Intervention that VII
  9. 9. ExecutiveSummary Early Childhood Intervention, Special delays, malnutrition, chronic ill health or Education and Inclusion: A Focus on disabilities. Belarus describes and analyses a variety of To assess the wide variety of services for programmes for vulnerable children with vulnerable children in Belarus, the authors developmental delays and disabilities. created a heuristic device: “Continua regarding Conceptual Approaches to ECI” This study documents the evolution of that is presented in Section II.6. In Part services for Early Childhood Intervention III, these continua were used to assess (ECI), special education, and rehabilitation prevailing special health, medical and for Belarusian children with special education services for young children needs from birth to six or eight years in Belarus. These assessments revealed of age. It includes definitions of key that a wide range of approaches is still terms, including: developmental delays used and further evaluation research is and disabilities; ECI services; special required to assess programme outcomes. education; defectology; and “child- centred,” “family-focused,” and inclusive In Part III, Chart III.1 Services for Special services. It reviews the nature of services Needs Children in Belarus presents a before the introduction of child-centred schematic overview of Belarus’ large and and family focused approaches in recent impressive system of health, medical and years, and it identifies some of the triggers education services. It then describes and that prompted the modernisation of analyses the country’s main programmes services as well as drivers that sustain for children with special needs, including: programme quality and continuous • Polyclinic-based Early Child- service improvement. The study focuses hood Intervention Centres; on these programmes’ normative, • Child and Adolescent Psycho- institutional and juridical status; structure neurological Dispensaries; and organisation; general service • Medical Rehabilitation Centres; coverage; and programme contents • Infant Homes; and approaches. In addition, the • Development Centres of the study provides some lessons learned, Ministry of Education; recommendations for the CEE/CIS region, • A wide range of preschools for and guidelines for ECI services. children with special needs; and Quandaries regarding prevailing • Family services of the Belarusian global, regional and national rates of Association of Assistance to developmental delay and disability are Children and Young People also discussed. The current status of with Disabilities. services for vulnerable children in the CEE/CIS region is also reviewed, along In Part IV, a series of triggers and drivers of with trends for moving from placement in the ECI and Special Education System are state care institutions to providing child- identified. Major lessons learned gleaned centred and family focused services for from this review of Belarusian services special needs children and their parents. for young children with special needs include: In section II.3, a Continuum of Early 1. Strong policy support, a legal Childhood Services is advanced as a basis for the ECI system, and conceptual framework regarding ways inter-sectoral agreements and countries can provide universal support guidelines promote the devel- for families with young children as well as opment of sustainable, cultur- more intensive and enriched services for ally appropriate, comprehen- children with risk status, developmental sive and continuous ECI serv- ices.VIII
  10. 10. 2. Former defectological systems, preventive and supportive concepts and methodologies child-centred and family- should be revised to ensure based services for families an effective special education with special needs children. and health system can be The costs related to infant developed. homes and orphanages3. Service eligibility criteria should be progressively should remain broad. shifted to the ECI and Special4. Outreach services are essential Education System along with to identify and serve all special the provision of high-quality needs children. parent education and support5. Inter-agency early identifica- services to ensure children tion, assessment, case manage- will be well cared for and ment, tracking and follow-up nurtured. Care must also be systems are needed to ensure taken to ensure the transition children are not “lost” in the is well programmed to provide system. quality care in residential6. Individualised family and child environments as children are service plans should include gradually transitioned to new the informed consent and foster homes or are adopted. active participation of parents 17. In addition to current insti- in all programme activities. tutional monitoring require-7. Comprehensive centre- and ments, ECI services should home-based ECI services design and implement results- should feature the full range based programme evaluation of service intensities plus systems in order to assess pro- child care and respite care, as gramme outcomes. needed. 18. Strategies for ECI programme8. Year-round ECI services are advocacy are needed. essential given continuous 19. In addition to public sector child and family support needs. services, it is essential to9. Belarusian parent education, provide support for NGOs, counselling and support universities, professional services have proven to be associations and other civil effective and highly used by society organisations. the parents of special needs 20. Basic research is needed on children. child status, ECI systems and10. Parent involvement in policy impacts. ECI services and centres is correlated with client In addition, recommendations are satisfaction. provided for regional training, exchange11. ECI’s Interdisciplinary Teams and networking in order to promote helped to achieve well- the development of ECI services, special integrated services. education programmes, and inclusive12. Guidelines are needed to preschools in other countries. manage ECI learning resources.13. Careful planning for the In Part V, Guidelines for Establishing transition of children and ECI Services are offered to help other parents from ECI services countries design rights-based, child- to inclusive preschools and centred, and family-focused ECI services. primary schools is essential. These Guidelines include core concepts14. Flexible approaches should and basic principles, structures and ranges be used for pre- and in-service of services, processes and methodologies personnel training. for establishing effective ECI services. The15. Inter-agency coordination roles authors welcome comments on these and Commission meetings Guidelines. should be revised to ensure, among other matters, that parents are able to decide on the futures of their children.16. The cost of institutionalising children with developmental delays and disabilities far exceeds the cost of providing IX
  11. 11. 12
  12. 12. IPART :Introduction 1
  13. 13. Part I IntroductionI.1 Early Childhood Intervention: an The incidence of developmental delaysessential part of all early childhood and disabilities throughout the worldsystems is only beginning to be discovered. For example, in the highly developed countryProgrammes for early childhood of Chile, a nationwide assessment ofintervention (ECI), special education infant and child development revealedand inclusive education should be high levels of developmental delayan essential part of all national early in young children, especially amongchildhood systems. Every society has families living in poverty. For infants frommany vulnerable children with special one to 23 months of age, delays variedneeds. These needs may be due to in municipalities from 23% to 40%. Forpoor birth outcomes, war, poverty, children from 24 months to four yearsfamine, insufficient nurturing care, an of age, delays varied from 28% to 46%impoverished learning environment, (Molina 2006). In response to thesepoorly formed early relationships, alarming figures, Chile currently is placingdisease, chronic ill health, biological or a major emphasis upon developing ECIchemical contamination, child neglect, services and inclusive preschool andfamily genetics, domestic abuse, or the school education.institutionalisation of “social orphans”1and disabled children. Such vulnerable A series of studies on the rate of returnchildren require intensive ECI services on investment in ECD revealed thatthat provide individualised attention to returns range from US $2 to $17 per dollarmeet their special needs. invested (Heckman et al 2000 – 2006). Economists and national planners findBrain research has demonstrated that it is these research findings most compelling.imperative to provide supportive services As a result of these and other studies, onfor pregnant women and young children October 25, 2007, leading internationalfrom birth to age three. During this economists participating in the Consultaperiod, approximately 80% of the brain is de San Jose, identified ECD as the firstdeveloped (Shonkoff and Phillips 2000). and most effective investment amongMost countries focus early childhood 29 priority areas for improving publicservices for children from birth to age spending and policies in Latin Americathree narrowly on primary health care, and the Caribbean. According to theand only begin to invest in preschool outcome document:education at age three or four. The criticalperiod of pregnancy to age three has Top priority was given to Earlybeen given relatively less attention. To Childhood Development programs.date, most countries have not established These are interventions that improvecomprehensive early childhood systems the physical, intellectual and socialfor parent education, early stimulation2, development of children early in theirand integrated services to meet an life. The interventions range fromarray of child development needs, from growth monitoring, day care services,high-risk and mild conditions to severemalnutrition, developmental delays or 2 Parents and caregivers conduct earlydisabilities. childhood stimulation and development activities, beginning at birth, to optimize infants and children’s perceptual, physical, mental, language, and social and affective development. In this study, infant stimulation is used to cover the full1 Social orphans are children who are in range of infant and child development activities.state care and without parental care, but who have It includes nurturing relationships, strong mother/at least one living parent. child bonding, and the promotion of positive socio-emotional development. 3
  14. 14. preschool activities, improved hygiene With respect to the scope of this study, Part and health services to parenting skills. II includes a brief review of definitions and Besides improving children’s welfare conceptual approaches to the fields of ECI, directly, the panel concluded these an overview of “defectology” in relation to programs create further benefits for special education and inclusive education family members, releasing women as well as a discussion of prevailing rates and older siblings to work outside the of children with special needs in the home or to further their own education. world, CEE/CIS region and Belarus. Part Evidence shows that the benefits are III provides an overview of the medical, substantially higher than the costs.3 health and educational systems and services provided for vulnerable children I.2 Objectives, limitations and scope in Belarus. In Part IV, some lessons learned of the study and recommendations are offered. Finally, Part V presents general guidelines The UNICEF Regional Office of CEE/ for the development of ECI services in the CIS established the following study CEE/CIS region and elsewhere. objectives: 1. To document the evolution of centres for ECI, development training and rehabilitation for young Belarusian children from zero to six or eight years of age with special needs, including: the nature of services before the introduction of “child and family friendly” approaches; triggers that prompted the modernisation of services; and drivers that sustain quality and continuous service improvement. 2. To characterise and assess ECI systems and services in Belarus with regard to: normative, institutional and juridical status; structure and organisation; general service coverage; and contents and approaches. 3. To develop general guidelines for the establishment of effective, rights-based, child-centred, and family-focused ECI services in the CEE/CIS region. Although these objectives were attained, this study has some limitations. We had very limited time for field work. Programme directors were universally present during our relatively short visits to each centre; in some sites professional personnel were on vacation, limiting opportunities to observe child, parental and professional interactions. Most materials were available in Belarusian or Russian, and key documents had to be translated for us. Several technical terms and types of specialists were substantially different from those used in other countries. As a result, some terms have been translated using rough equivalents in English. 3 See website for additional information: http://www.iadb.org/res/ consultaSanJose/files/outcome_eng.pdf4
  15. 15. PART II:Definitions, Conceptual Approachesand Context 5
  16. 16. Part II Definitions, Conceptual Approaches and ContextIn 2007, UNICEF established new children with more complex disabilityprogramme guidance regarding Children appropriately.” (p. 9)with Disabilities: Ending Discrimination Part II addresses definitions andand Promoting Participation, Development conceptual approaches used to assessand Inclusion. This guidance provides a and identify children with developmentalframework for ensuring all children will delays, malnutrition and disabilities, andbe given an opportunity to develop their to provide child-centred and family-potential. It states: focused services. It also discusses “Programming can incorporate global, regional and Belarusian rates of attention to the issues raised by vulnerable children as well as reviews childhood disability in different ways programme approaches developed in across the life cycle. In the early years, CEE/CIS countries. Part II also presents early detection and intervention, a general continuum of early childhood as well as family support come to services and discusses issues regarding the fore. Early intervention is critical defectology, special education and and holds tremendous potential for inclusion. success. It requires high awareness among health professionals, parents, teachers as well as other professionals working with children. Family- and community-based early intervention services should be linked up with early learning programmes and pre-schools, which meet the needs of children with disabilities and facilitate their smooth transition to school. (p. 7) “Efforts to incorporate attention to children with disabilities in UNICEF health and nutrition programming should focus on improving strategies for early detection, referral and intervention and promoting equal access to health services.” … “As seen in numerous community-based rehabilitation (CBR) programmes, early screening and simple community-based interventions by front-line workers have shown to be an effective tool for improving the lives and functioning of persons with a disability... However, early screening and diagnosis must be linked to the provision of timely and appropriate support and advice to families, combined with the design and orientation of a corresponding intervention plan for more complex problems and for developmental delays. Efforts should focus on building the capacity of health workers and others in the community to provide advice and assistance to parents, as well as to refer 7
  17. 17. II.1General definitionsand approaches to ECI Definitions and conceptual approaches Children develop in a holistic manner are essential to understanding the fields and evolve dynamically over time of ECI, special education and inclusive in response to their environments.4 education. The status of children targeted Because of this, both typically developing by these programmes is a complex topic. children and those with developmental They include children at high risk of delays or disabilities require balanced developing delays or disabilities, children support in all areas of development, that have developmental delays, and including perceptual, fine and gross children with disabilities. motor, language, cognitive and social/ emotional development as well as II.1.1 Child status health and nutrition in order to achieve their innate potential. To achieve Children who are at risk of developing balanced development, early childhood delays and disabilities include those programmes use integrated approaches with poor birth outcomes, biological that include basic services for preventive or genetic risks, or whose parents live health care, nutrition, early nurturing, in poverty, have low levels of formal stimulation and child development education, or suffer from domestic activities, home and community violence, substance abuse, violent sanitation, and in cases of special need, conflicts, famine, diseases, poor sanitation juridical protection and protective or other negative situations. services. A child is considered to have a II.1.2 Special education needs developmental delay when he or she is assessed to have atypical behaviour Special education can be defined as or does not meet expected normal educational and social services provided development for actual or adjusted by preschools, schools and other age in one or more of the following educational organisations to children areas: perceptual, fine or gross motor, usually between the ages of two and social or emotional, adaptive, language one-half or three years of age to 18 to and communication, or cognitive 21 years of age. ECI services usually development. A delay is measured begin before special education services by using validated developmental are provided but in some countries, ECI assessments. The delay may be mild, programmes are included within special moderate or severe. Poor birth outcomes, education services, as is the case in inadequate stimulatio and nurturing care Belarus. from birth onward, organic problems, psychological and familial situations, or The OECD classification of children with environmental factors can cause delays. special education needs is as follows: Cross-national category “A/Disabilities”: A child is considered to be disabled if Students with disabilities or impairments he or she has a physical, health, sensory, are viewed in medical terms as organic psychological, intellectual or mental disorders attributable to organic health condition or impairment that pathologies (e.g. in relation to sensory, restricts functioning in one or more areas, motor or neurological defects). The such as physical movement, cognitive educational need is considered to arise and sensory functions, self-care, memory, primarily from problems attributable to self-control, learning, or relating to these disabilities. others. Many national and international 4 Holistic development refers to integrated typologies of disabilities list impairments and balanced development in all areas, including by type. physical, social, emotional, language and cognitive development.8
  18. 18. Cross-national category “B/Difficulties”: medical, nursing and nutritionalStudents have behavioural or emotional services; and parent education anddisorders, or specific difficulties in support services, including referrals andlearning. The educational need is protective services, if required. They seekconsidered to arise primarily from to identify high-risk, developmentallyproblems in the interaction between the delayed, and disabled children at or soonstudent and the educational context. In after birth or the onset of special needs.the survey of special educational needs They also identify delays that appearprovision among member countries for later due to situations such as poverty,school year 2000/2001, “mild mental lack of early nurturing and stimulation,handicap” was changed from category B malnutrition, chronic ill health, war, lossto category A. (OECD 2005, pp. 14 and 26) of parents, neglect, abuse, child labour, and so forth. By focusing on children’sCross-national category “C/Disadvan- environments, ECI services help removetages”: Students have disadvantages aris- barriers to development in terms ofing primarily from socio-economic, cul- social and educational conditions as welltural and/or linguistic factors. The educa- as environmental adaptation and thetional need is to compensate for the dis- provision of technical aids.advantages attributable to these factors. An additional ECI definition describes theAlthough widely used, the OECD range of potential programme servicesclassification for children with special and impacts. For example, Shonkoff andneeds focuses on disability rather than Meisels state:ability. It does not include learning “Early childhood intervention consistsopportunities from the removal of of multidisciplinary services providedbarriers or achievements that can result to children from birth to 5 years of agefrom giving each child positive support to promote child health and well-being,for attaining his or her potential. The enhance emerging competencies, minimizeearly childhood intervention approach, developmental delays, remediate existingpresented next, stands in stark contrast or emerging disabilities, prevent functionalto this classification’s focus on disability. deterioration, and promote adaptive parenting and overall family functioning.II.1.3 Early childhood intervention These goals are accomplished by providing individualized developmental, educationalMichael Guralnick defines early and therapeutic services for children inchildhood intervention “…as a system conjunction with mutually planned supportdesigned to support family patterns for their families.” (2000, pp. xvii-xviii) In essence, ECIof interaction that best promote child programmes providedevelopment” (2001). From the parents’ ECI services usually begin at or shortly a system of earlypoint of view, Texas ECI services are after birth, and depending upon need, childhood services anddescribed as follows: “Children grow and should continue until developmental support for:learn, or develop, a lot during their first three goals are achieved and consolidated, theyears. Although each child is special and child enters preschool or school, and/ 1) vulnerablegrows and learns at his or her own pace, or reaches six to eight years of age. The children at high risksome children need extra help. This extra length of time ECI services are provided for developmentalhelp is called early childhood intervention.” varies from country to country: from birth delays or with(Texas ECI Handbook 2006.) Shiela to three years of age, or from birth to confirmedWolfendale asserts that an ECI programme school entry or five to eight years of age. In developmentalhas several goals: “Firstly, it is provided to countries with strong inclusive preschool delays or disabilities,support families to support their children’s education programmes, ECI services often anddevelopment. Secondly, it is to promote focus mainly on the critically importantchildren’s development in key domains such period of birth to three years of age. 2) their parents andas communication or mobility. Thirdly, it is Where they exist, ECI services are usually families.to promote children’s coping confidence, provided to both parents/families and toand finally it is to prevent the emergence of children. For this reason, ECI services are The primary goal offuture problems.” (1997). universally family-focused and feature ECI programmes is parent empowerment, education and to support parents inECI programmes include an array of support. When ECI, special education helping their children tobalanced activities with infants and and inclusive services are joined together, use their competenciesyoung children to encourage their inclusive services may continue until they to achieve their fulldevelopment in different domains reach 18 years of age. developmental potentialthrough a variety of methods: physical, and attain expectedlanguage and occupational therapies; levels of development,special education and inclusive services; to the extent possible. 9
  19. 19. II.2Children with developmentaldelays or disabilities II.2.1 Global rates of developmental both physical and socio-cultural at-risk delay and disability factors. Early childhood services are particularly important for such children, The global rate of developmental delay and contribute strongly to their health, and disability is not known. Some social and cognitive development, as estimate there may be 150 million well as to the social inclusion of their children with disabilities alone worldwide, families and their future participation indicating a prevalence rate of only in society. Moreover, these services fulfil 1.3%, which must be a vast undercount an early screening function in detecting (Committee on the Rights of the Child special needs which, if identified 2006). The World Bank estimated that sufficiently early, can be treated more 40 million of 115 million out-of-school effectively, including the provision of children have disabilities, including those support to families.” (Bennett 2006, p. with moderate disabilities, and at least 92). 25% of the world population is affected In Starting Strong II, OECD’s Education by disabilities. (World Bank 2003) The Directorate presents the following numbers of children, who are at risk of statistics for OECD member countries developmental delays or disabilities or using the categories presented earlier are already affected by them, vary greatly regarding the frequency of varying levels from country to country depending of risk, delay or impairment:5 upon: poverty rates; basic health care; birth outcomes; parental educational and Category A/Disabilities: These are economic levels and other circumstances. conditions that affect students from Many more children are affected by all social classes and occupations, developmental delays than originally generally around 5% of any OECD thought, as demonstrated by the Chilean population. national study of Dr. Helia Molina, noted above. However, many national planners Category B/Difficulties: These learn- believe that only a small percentage of ing disabilities are often temporary in children are affected by delays, such as nature, and afflict a small percentage – from 4% to 5%. This belief has been used around 1% – of any population. as an excuse for neglecting to budget adequate funds for essential health and Category C/Disadvantages: This education services for children with is a large group in many countries developmental delays or disabilities. ranging from 15% to 25% of children in any given urban population.” Regrettably, few countries have reliable (Paraphrased from Bennett 2006, pp. counts of children with high-risk status, 97 – 98)6 delays and disabilities. Starting Strong II states, 5 The OECD member states are: Australia, Efforts to improve equitable access Austria, Belgium, Canada, the Czech Republic, target primarily two categories of Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, children: children with special needs Luxembourg, Mexico, the Netherlands, New due to physical, mental or sensory Zealand, Norway, Poland, Portugal, the Slovak disabilities; and children with Republic, Spain, Sweden, Switzerland, Turkey, the additional learning needs derived from United Kingdom and the United States. family dysfunction, socio-economic disadvantage, or from ethnic, cultural 6 For Category C, due to a relative lack of adequate health and education services, the rates or linguistic factors. In practice, many of developmental delay and disability in rural areas children in need of special or additional of OECD nations tend to be higher. educational support have accumulated10
  20. 20. In some parts of the Soviet Union,Adding these rates together, from 21% to nursery care was less available; however,31% of young children in OECD countries young children were usually placed inare affected by/or at risk of developmental preschools in order to release mothersdelays or disabilities, a figure not totally to work outside the home. Infants anddissimilar to Molina’s findings in Chile. young children who were considered toThis high level of need for ECI services has have a “defect” or other disability wereenormous implications for educational sent away to institutions and they rarelyachievement, social service costs, and were able to leave them during theirnational productivity. lifetimes. Defectology was developed as a discipline for identifying and caringNational coverage of special and inclusive for these children (See Section II.4).education services that are enriched, Parent education was not provided,more intensive, and longer in duration has and State responsibility for child rearingbeen attained only in Australia, Europe, was emphasised while families wereNew Zealand, North America and a few given a lesser role as helpers of Statecountries of Latin America. These realities institutions. All of these circumstancesmake the achievements of Belarus, a led to a situation where many present-country in transition, all the more striking. day families do not esteem parenting andSimilar to many industrialised countries, lack basic parenting skills.Belarus has developed a large ECI andSpecial Education system. At the start of transition, several CEE/CIS countries experienced major economic It can no longer beII.2.2 Services for children with special and social dislocations and highly diverse sustained that ECIneeds in CEE/CIS region approaches to ECD arose, depending and special education upon historical, institutional, cultural, programmes wouldBefore the founding of the Soviet Union, religious and economic circumstances. serve only a smallRussia had developed a wide variety of However, a few general statements may percentage of a nation’spreschools. (For a rich discussion, see be made about the region as a whole. children in non-OECDTaratukhina et al 2007.) However, after the Poverty indices rose sharply and in many countries. To ensureOctober Revolution, private or otherwise countries, health, educational and social all children reachindependent preschools were ended services were severely curtailed, leading their developmentalor transferred to People’s Commissariat in most but not all countries, to a rapid potential, nations needof Education. Thereafter, State-funded deterioration in primary health care, to target services to fromprogrammes provided centre-based preschool education, and many other 30% to over 50% of eachcare for newborns and young children: social services upon which most families birth cohort. For nations1) to enable mothers to work after two had become dependent. In addition, to meet their humanmonths of rest after childbirth; and 2) with privatisation, where national and/ rights commitmentsto form children into citizens devoted or local governments did not mandate and become productiveto collectivist approaches wherein the maintenance of preschool services, and competitive inindividual creativity and initiative were coverage tended to decline precipitously. the world, it will benot fostered (Zafeirakou 2006). Since 2000, many of these countries are necessary for them recovering economically, and they are to establish policiesAs noted by Taratukhina, “…the Soviet rebuilding and reforming their services and cost-effectivesystem was quite effective in dealing with for young children and their families. programmes for ECI andthe tasks set by the State. It was: stable; In general in the region, programmes special education as corewithout competition; not arbitrary; settled for early childhood tend to have low elements of servicesand in keeping with Russian habits and coverage and be directed and managed for early childhood andmentality; a prop of the existing social by the public sector. In some cases parenting.system; the same for all 15 component there is collaboration with civil societyrepublics of the USSR; centralized; without organisations, such as the Step byright of initiative or independent decision Step NGOs established by the Sorosmaking; easy to manage from above Foundation Network, International Babybecause of its uniformity. From the mid- Food Action Network (IBFAN), and others.1980s (the beginning of perestroika) there Increasingly, NGOs, universities, instituteswas a gradual transfer from a unitary and private initiatives are playing keydenationalized education system to roles in ECD in many of the countries.a democratic, multiple and ethnically Residual pre-transition programmesorientated education system. Russia saw and newly developed ones tend to bethe revival and qualitative improvement clustered in urban centres. Most CEE/of national schools and the restoration of CIS countries are experiencing serioushumanist traditions in education. (p. 6) challenges in reaching rural areas and excluded ethnic and linguistic groups. The decentralisation of governmental 11
  21. 21. services has revealed a lack of capacity Specifically, the figure rose from 500,000 at municipal and community levels for children at the time of transition to 1.5 comprehensive ECD planning, including million children officially designated to for ECI services. In general, as countries have disabilities in 27 countries. (UNICEF have not formulated ECD policies, 2005 p. 2) This increase may not be real plans, legislation, standards, evaluation, since it is surmised that countries have quality assurance and accountability become more adept in recent years at systems. Only a few countries have identifying and reporting disability. developed incipient ECI systems. In this, Belarus is leading the way through the In the former Soviet Union, most children establishment of its large, varied and with disabilities were institutionalised. quite integrated ECI and special education They were never seen, and if they were, system. they became the object of discrimination (Sammon 2001). Furthermore, when In CEE/CIS countries, until recently children with disabilities entered infancy to three was considered mainly preschools, they tended to be isolated the responsibility of parents and and received a poorer quality of education health care systems. There is growing and were unable to form social ties. When acknowledgement of the need to segregated into institutions, they rarely develop comprehensive ECD systems for were able to rejoin society during their parents and children starting from the lifetimes. The 2005 General Comment prenatal period. With respect to children Number 7 on the UN Convention on the over three years of age, in Central Asia, Rights of the Child states, “Early childhood preschool education declined after the is the period during which disabilities fall of the Soviet Union; however by are usually identified and the impact on 2004, the preschool gross enrolment rate children’s well-being and development had risen to 27%. In Central and Eastern recognized. Young children should never Europe, gross preschool enrolments also be institutionalized solely on the grounds of dropped but had recovered by 2004 disability. It is a priority to ensure that they with an average gross enrolment rate of have equal opportunities to participate fully 57% in the region, with great variation in education and community life, including among the countries. However, children by the removal of barriers that impede the from the poorest backgrounds who realisation of their rights. Young disabled stand to benefit most from ECD services children are entitled to appropriate tend to be most likely to be excluded specialist assistance, including support for from preschools. “Many children from their parents (or other caregivers). Disabled ethnic minority groups are mislabelled children should at all times be treated with as ‘developmentally delayed’ and lack dignity and in ways that encourage their access to essential services.” (Sammon self-reliance.” 2001, p. 9) Better family income, majority status, urban residency, higher maternal UNICEF estimates that about 1.5 million education levels, birth registration, and children in the CEE/CIS region live in the presence of an immunisation record, institutions and other out-of-home are associated with the likelihood of care arrangements, and of them, at preschool attendance in the region. least 317,000 had disabilities. These (UNESCO 2006, pp. 3-6) In South East institutionalised children tend to be either Europe, services for children from birth to disabled or among the most vulnerable, three and for preschool education tend and in most countries of the region, to be severely limited, especially for rural they usually lack access to ECD services and excluded groups. (Zafeirakou 2006) and quality preschool opportunities. A growing emphasis on social equity is Jonsson and Wiman estimate that in leading to new ECD initiatives, and to Eastern Europe, 60% of all children interest in developing ECI services in placed in institutions are disabled (2001, countries such as Bosnia and Herzegovina p. 9). The study by UNICEF’s Innocenti and Albania. Centre found that in the CEE/CIS, children with disabilities have an 18% chance of Countries of the CEE/CIS region use being institutionalised. Other typically different definitions of disability, and developing children have only a 0.39% systems for identifying children are chance of becoming institutionalised. not well developed in most countries. Overall, they estimate that a child with UNICEF’s Innocenti Centre estimated disabilities in CEE/CIS is 46 times more that there had been a threefold increase likely to be placed in an institution in children with disabilities between (UNICEF 2005). the start of the transition and 2005.12
  22. 22. A study in the Russia Federation revealed institutes that continue to prepare health,that many children continue to be placed education and other professionals.in institutions because their communities Populations tend to have higher levelslack essential supportive services. They of formal education than many otherstated, “The health, education, and social world regions. The public health systemservices necessary to permit children to has been weakened but it is still intactremain in the community with their own in most CEE/CIS countries, and usuallyfamily or with substitute families are it has retained some home visiting andlacking. … The near exclusive reliance on polyclinic primary health care servicesinstitutional care for children who require that could be improved and expanded tosupport contributes to the disabilities of provide many ECI services. Although thechildren. Research in child development number of preschools initially declined,and the experience of other countries curricula and methods have been largelyaround the world has demonstrated that revised, and preschool services are beingchildren experience developmental delays expanded in most countries. Optionsand potentially irreversible psychological for avoiding institutionalisation aredamage by growing up in a congregate under consideration and new parentenvironment. This is particularly true in the support services are being institutedearliest stages of child development (birth in several countries. Vivid interest hasto age four), in which the child learns to been expressed in expanding inclusivemake psychological attachment to parents education and some inclusive preschools(or substitute parents). Even in a well- and schools are being developed.staffed institution, a child rarely gets the Countries are beginning to consideramount of attention he or she would receive developing ECD policies and plans, andfrom his or her own parents. Consequently, in many countries, they are taking an Poverty, familyinstitutionalisation precludes the kind of integrated and comprehensive view of problems, stigma, andindividual attachments that every child the early childhood field, including the a lack of informationneeds” (Rosenthal et al 1999). Indeed provision of ECI and inclusive services. and community-basedUNICEF found that most children with options lead parentsdisabilities in the region come from II.2.3 Delay and disability in Belarus to seek help frompoverty-stricken families. (UNICEF 2005, institutions.p. 2) Definitions of developmental delay and disability in Belarus differ from those In addition to highlyWith support from international generally used by OECD countries. The detrimental effects oforganisations including UNICEF, the Ministry of Education (MOE) reports that institutionalisation onWorld Bank, and the Open Society of the nearly 2 million children from child development,Institute, among others, countries in the birth to 18 years of age, 125,981 children institutional careregion are working to de-institutionalise (6.3% of all children) are affected by is far more costlychildren, and especially those with disabilities, and of them, approximately than community ECIdisabilities. (Tobis 2000) For example, 30,000 children (1.5% of all children) are programmes, inclusivein the Former Yugoslav Republic of considered to be severely delayed or preschools, andMacedonia, the Ministry of Labour and disabled. parenting services.Social Policy (MOLSP) is developing newpolicies and alternative care options Of the 125,981 children from birth tosuch as community-based services age 18 reported to have disabilities, theand day care centres. They are training following statistics are provided by thepersonnel, reuniting children with their MOE:families or placing them with carefully • Number of children identifiedscreened, selected and trained foster to have delays and disabilities,families and developing small group from birth to three years of age:homes where necessary (UNICEF 2007). 6,740In general, countries of the region are • Number of children, four to fivelooking for alternative, positive options to years of age: 33,943institutionalising children with disabilities • Total children birth to six years ofand other social orphans, and they are age: 40,683trying to go beyond the provision ofwelfare payments and disability pensions The total number of children from infancyfor children. (UNICEF 2005) to six years of age was reported to be 632,913 for 2006, with 40,683 identifiedFortunately, the CEE/CIS region has to have a disability, yielding a disabilitysignificant strengths upon which to build rate of 6.4% of the children less than sixits ECD and ECI services. Most of the years of age. This disability rate is virtuallycountries have retained strong institutions identical to that of the general populationof higher education and technical of children from birth to 18 years of age. 13
  23. 23. This disability rate is slightly higher than Before transition, most children with the general rate of 5% for OECD countries. disabilities were separated from their families, placed in Infant Homes, and Of concern is the major difference later transferred to orphanages. Today between the numbers of children in Belarus, about 33,000 children are identified to have disabilities from birth orphans or denied parental care. Many to three years of age (6,740), in contrast of them have disabilities and do not have to those who are from four to six years contact to a stable family. They remain of age (33,943). Greatly expanded “invisible children” who are rarely seen attention needs to be given to home in everyday life. These children with and community outreach to identify all disabilities receive more developmental of the infants and toddlers who are high- services than before but they lack loving, risk, delayed or disabled. The MOE states stable parents. It was reported that many that, in collaboration with the Ministry infants become social orphans especially of Health (MOH), it serves virtually all because of the high 68% divorce rate. In identified children. 2006, there were 73,000 marriages but over 30,000 divorces. In Belarus there are With respect to the types of disabilities over 355,000 single parent families, and found in Belarus, the MOE reports the only 12,000 of these are father-headed following: families. Because of the high divorce • 74.5% have speech/language rate and related social issues such as delays substance abuse, family violence, and • 14.4% have “difficulties child abandonment, new family therapy learning” programmes are being developed • 13.8% have cognitive delays throughout Belarus. • 11.0% have physical disabilities • 5.0% have problems with In addition to family therapy, Belarus eyesight or blindness is expanding its ECI and rehabilitative • 1.6% have auditory challenges services, experimenting with special • 2.6% have motor delays7 education and inclusive approaches in crèches and preschools, and has This list totals 125%, indicating that developed a country-wide parenting some children have more than one education effort that is nested within all type of disability. However, usually health, medical and education services higher rates of multiple disabilities are that work with the parents of young encountered, so these figures may be a children. The strong and supportive large undercount. Also the proportion Positive Parenting Programme (PPP) of speech/language delays seems to be that was developed with support from extraordinarily large and cognitive delays UNICEF serves all programmes for young quite low, for they often go hand in hand. children in Belarus (Vargas-Barón 2006). Physical disabilities also seem to be low. To strengthen the PPP, the “Successful Although the MOE has made a major Childhood Development Centre” was effort to identify such children, additional officially inaugurated in 2007 with work is needed to identify and categorise strong official support. This resource disability. centre for the parenting programmes is located in the Belarusian State According to the 2005 Multiple Indicator University. A post-graduate university Cluster Surveys (MICS) for Belarus, 3.8% of programme is also envisaged to prepare children are born at or below 2,500 grams. early interventionists and upgrade This rate is low but all of these fragile other specialists. In addition to general children need special care to prevent parenting resources for specialists long-term delays or disabilities. Because and parents of typically developing of universal health service coverage, it children at low risk of developmental should be fairly easy to ensure all such delays, several books and booklets for children are promptly identified and parents of children with high-risk status, referred for ECI services. Malnutrition developmental delays or disabilities, have is rarely found in Belarus, and the MICS been developed, field-tested, produced identified less than 1% of children with and distributed. malnutrition. 7 A variety of assessment and screening instruments are used. A standardised system has not been established.14
  24. 24. II.3 Continuum of early childhood servicesECI services represent the most intensive as soon as possible in order to avoidpole on a continuum of national-level the occurrence of serious delays. Manyearly childhood services. The following children with developmental delays thatmatrix refers especially to services for begin services at the most intensive endchildren from birth to 36 months of age. of the continuum move to moderatelyFor children with high-risk status at birth intensive services within 9 to 12 months,or potential developmental delays or and some will attain “normalcy” anddisabilities, it is essential that they enter then consolidate their gains throughECI types of services soon after birth. participating in the least intensive servicesOther children are identified after birth, listed at the right end of the continuum. Chart II.1: Continuum ofand they should be assessed and served Early Childhood Services Service Intensity Most intensive Moderately intensive Least intensive ECI + parent education & Focused ECI/ECD services + ECD services + parent educa- Services Type of services support parent education & support tion & support, as needed High risk of developmental Level of risk Moderate risk of delay Low or no risk of delay delay Very high risk of delay, in- Improved, mild delay, or only No delay or low to no risk of Degree of delay cipient to severely delayed at risk of delay delay Disabled or at high risk of Child Status Degree of disability Mild or no disability No disability risk disability Moderate to severe Mild malnutrition, Nutritional status* Normal nutrition malnutrition consolidating gains Severe or chronic disease Improved health but still at Preventive & basic health Health status or illness risk status & care Intensive, frequent child & Regular, less frequent child & Annual child & family Assessments family assessments family assessments assessments Home & centre-based Centre-based, with fewer Service locations Centre-based services only services home visits Frequent visits or sessions Less frequent (biweekly, Sessions upon request, Service frequency (daily to weekly) monthly) usually centre-based Service Continuous services of Duration dependent on need Shorter, episodic & upon Service duration Aspects long duration & improvement request Moderate (45 minutes to 1 Short, vary with parental Length of sessions Longer (1 to 2 hours+) hour) request Early interventionists, ther- Early interventionists, supervi- Early childhood home visitors Service providers apists, nurses, physicians sion from therapists, others & parent educators, others Roles of para- Assistants, home visitors, Assistants, home visitors, Supervised assistants professionals supervised by specialists supervised by specialists & parent educators* WHO standards for nutrition will be followed. 15
  25. 25. II.4Defectologyand special education Within the framework of intensive early child. It also employs other diagnostic childhood services, during the 1920s, and nosological labels, which in the ECI- the field of defectology, with Vygotsky8 perspective of today, are considered to be as its pioneer, was established in the degrading, like “oligophren,” “moron” and Soviet Union as a special discipline so on. dealing with impairments, disabilities and developmental delays. Although The deficit approach is logically related Vygotsky was a precursor of modern to the orientation of goals for service special needs education, his early writings provision and intervention, which is on defectology were not followed. summarised in the term “correction.” Later on, in its treatment applications, Diagnosis points to what is wrong, deviant defectology developed into a correctional from normality, and the consequent and socially segregating system. Children next step is to attempt to correct this with delays or disabilities were closeted deviance. Correction is considered to be away, and few rejoined society and a matter of treatment, training, therapy their families (Rosenthal et al 1999). or compensation, and it is believed To grasp the specific character of the that highly experienced and skilled defectological orientation, in comparison professionals are required to accomplish to the normative orientation underlying this treatment. Since this is considered to the ECI perspective, it is important to pay be the case, laypersons are not generally attention to conceptions held regarding seen as resources or as horizontally related the child, service objectives, and key partners in intervention and support. principles for the organisation and Parents are – at the most – receivers of provision of services. prescriptions of regimes. Other children are seldom seen as potential resources In its conception of the child, defectology within the treatment plan. Inclusion, if is oriented to deficits, rather than at all considered, is consequently judged competencies. Assessment is considered from the perspective of treatment to be solely a diagnostic procedure and training: if it leads to comparable aiming at identifying deviances from correction outcomes it might be seen what is assumed to be normal. The cause as an option. (In the case of preschool of a special need, as well as eligibility for and school inclusion, such an outcome, support, is thought of as a “pathology,” however, is rarely considered, because in terms of physical, mental, sometimes special support is, with few exceptions, also moral development, and the child not given within the mainstream school is consequently conceived of as an context.). “invalid.“ This can be contrasted with the never ending, and sometimes ridiculed, Defectological service provision is discourse about the “correct” way of organised as a highly specialised service, terming a situation where the individual and it is usually centre or institution child has a need for special support in bound. Identification of needs was, in development, health, learning, social the early years, a task for regular medical participation or whatever. While the health controls. ambition, reflected in this discourse, is to identify and understand disabling or restrictive circumstances and barriers, and concentrate efforts on removing them, the defectological perspective frequently uses the term ‘invalid’ to characterise the 8 Collected Works of L. S. Vygotsky, Vol II: Fundamentals of Defectology (Abnormal Psychology and Learning Disabilities). Kluwer 1993).16

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