developing an inclusive education & ecd strategy...5 about the report this report is the final...
TRANSCRIPT
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AXCVH ACVBMJUYTRSZ KMJN B B
FACULTY OF MEDICINE UNIVERSITY OF KELANIYA
Developing an Inclusive
Education & ECD
Strategy
Final Report
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The report was compiled by:
K Manuja N Perera
A Pathmesweran
A R Wickremasinghe
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Acknowledgments
Vice Chancellor, University of Kelaniya
Dean, Faculty of Medicine, University of Kelaniya
Heads and academic staff of Departments of Disability Studies, Psychiatry and Peadiatrics, Faculty
of Medicine, University of Kelaniya
Director, Rehabilitation Hospital, Ragama
Provincial Directors of Health Services, Eastern, Uva and North Central Provinces
Regional Directors of Health Services, Anuradhapura, Batticaloa and Moneragala Districts
Medical Officers of Health and staff of MOH offices in Madawachchiya, Moneragala and
Oddamawadi MOH areas
Dr. C. Weerasinghe, Dr. H. Narammalage, Ms. U. Perera, Mr. F. Nifraz, Ms. J. Pinto, Ms. K. Herath
for their valuable services in the expert panel review.
Ms. N. K. Liyanage and Dr. C. Senanayake, Project coordinators
Ms. C. Upekshika, Ms. U. Senanayake, Mr. K. Wasala and Mr. L. Weerasinghe, supportive project
staff
Mr. S. De Alwis, Audiovisual Unit, Faculty of Medicine, University of Kelaniya
Demonstrators, Departments of Disability Studies, Psychiatry and Public Health
All research assistants
All parents and children who participated in the study
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The List of Contributors
Prof. AR Wickremasinghe
Department of Public Health
Faculty of Medicine, University of Kelaniya
Prof. A Pathmeswaran
Department of Public Health
Faculty of Medicine, University of Kelaniya
Dr. LeenikaWijeratne
Department of Psychiatry
Faculty of Medicine, University of Kelaniya
Dr. ChamilkaJayasinghe
Department of Paediatrics
Faculty of Medicine, University of Kelaniya
Dr. AnuradhiniKasthuriratne
Department of Public Health
Faculty of Medicine, University of Kelaniya
Dr. ShyamaniHettiarachchi
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
Ms. PavithraGodamunne
Department of Public Health
Faculty of Medicine, University of Kelaniya
Ms. RenukaFonseka
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
Dr. Manuja Perera
Department of Public Health
Faculty of Medicine, University of Kelaniya
Ms. DeepaniSiriwardhana
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
Ms. WasanaDahanayaka
National Rehabilitation Hospital
Ragama
Ms. NelunikaSamarasekara
National Rehabilitation Hospital
Ragama
ThiliniLokubalasuriya
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
GayathriSivasubramaniyam
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
EranthiChathurika
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
BandiniJayasena
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
ChinthikaPerera
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
LakshikaUdugama
Department of Disability Studies
Faculty of Medicine, University of Kelaniya
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Table of Contents
Chapter Page No:
01 Introductionand Objectives 6
02 Problem statement and justification 7
03 Implementation 11
04 Phase I – Review of existing services for preschool children with disabilities 14
05 Phase II – Development of resource materials for inclusive pre-school
education
18
06 Phase III – Prevalence of disabilities in preschool agedchildren 25
07 Phase IV – Dissemination of Results and Training of trainers on inclusive
preschool education
32
08 Conclusions and Recommendations 34
Annex A – Working group 35
Annex B – Indicators to identify disabilities in pre-school children 36
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About the report
This report is the final submission to Plan Sri Lanka, by Faculty of Medicine, University of Kelaniya on
the project “Developing an Inclusive Education and ECD Strategy”. The first chapter gives an
introduction to the project and the partnership between the two agencies. The need for the project
and basic principles governing the actions are described in Chapter two. Chapter three describes the
activities undertaken and methods of implementationin detail. Subsequent chapters describe the
component phases followed by conclusions and recommendations for future activities.
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Introduction
Plan Sri Lanka invited Faculty of Medicine, University of Kelaniya to provide technical support to
develop a strategy on how to work with pre-school aged children with disabilities. This invitation
probably was inspired by the fact that it is the only Faculty in Sri Lanka that has a separate department
on Disability Studies. Department of Public Health provided the leadership to the project and
resource persons from other departments and from the National Rehabilitation hospital worked
together to make the project a success. The project period was from 14th June 2013 to 30th June 2014.
The University’s role included overall management and control of implementation of the project;
maintaining records and documentation. The project had four objectives.
Objectives:
1. To describe the facilities for preschool aged disabled children to access preschool services
and quality of services.
2. To develop resource material for training of pre-school teacher trainers on facilitating
preschool education for disabled children.
3. To train a core group of practitioners in 3 provinces as specified by the Uva, North Central
and Eastern ECCD authorities/bureau on how to train preschool teachers using the
resource material.
4. To determine the prevalence of disabilities among children aged 2-5 years through a
screening process, in one DS division in each of the Districts (Anuradhapura, Batticaloa and
Moneragala).
The need for the project and background is described in the subsequent chapter.
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Problem Statement and Justification
Any person who, as a result of any deficiency in his physical or mental capabilities, whether
congenital or not, is unable by himself to ensure for himself, wholly or partly, the necessities of life
is referred to as a “person with disability”1. Disabilities in childhood can lead to negative lifelong
consequences. Disabilities in childhood can lead to issues in formation of identity, self esteem and
social interactions. As adults they are reported to be as having poorer health, lower education
achievements and lower economic status2. Therefore early identification and correction or
rehabilitation is essential to improve the quality of life of a person with a disability.
Even though there is a well established information system related to child health, there is no routine
surveillance for disability in childhood in Sri Lanka. In Sri Lanka, 99.5% of deliveries occur in
institutions. The newborns are subjected to neonatal examination by a trained medical officer prior
to discharge. Public health midwife (PHM), the field health worker responsible for child health will
visit the neonate in the home at least once during the first 10 days and around 4 times in the first 6
weeks. She is supposed to screen the newborn for any danger signs and disabilities. Until five years,
parents are supposed to assess the child’s development using the guidelines given in the child health
development record and PHM is supposed to confirm them based on parents’ reporting. If any
anomaly is identified, the child will be reported to the field child health clinic, in which a medical
officer will further assess the child and refer to necessary care. Even though this is the system,
whether it is practically implemented is an issue. Furthermore, data related to disability or
developmental delay is not transferred to the national level via the existing information system.
School going children are screened for disabilities in the school health programme conducted by
Family Health Bureau (FHB)3,4. There is a regular flow of disability related data in this population,
even though whether it is used effectively at policy level is questionable. Even at the grass root level,
it may be too late to address the identified disabilities. Therefore an attempt to identify disabilities
in the early childhood period, in the preschool setting is justified.
1Protection of the Rights of Persons with Disabilities Act, No 28 of 1996 2World Report on Disability WHO, 2011 3 Family Health Report, FHB, 2014 4 Child Health Development Record, FHB, 2012
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Disability is a complex condition, arising from the interactions between a person’s capacities which
are different from others and the society in which he or she lives. Therefore, interventions to remove
environmental and social barriers are required to overcome the difficulties faced by people with
disabilities. The facilities available for the children with disabilities play a major part in improving
their quality of life as well as ability to reach their maximum potential. In Sri Lanka, Ministry of Social
Services is responsible in providing services to the disabled5. Ministry of Health through its Unit for
Young, Elderly and Disabled (YED) coordinates activities on behalf of the ministry. Ministry of
Education also has a unit for Special Education to coordinate education related activities to the school
aged disabled children. Except for the ministry of health, the other two ministries have provincial,
regional and divisional secretariat level officers to coordinate services and activities related to
individuals with disabilities5,6. There are no studies published on the field level facilities available for
disabled children in Sri Lanka, therefore the present project explored those services in the selected
districts with the aim of recommending improvements as well as to assess the feasibility of
implementing inclusive education and ECD interventions.
With the national school enrollment rate as high as 96%, many children with disabilities still
do not go to school. For example, 67% of adults with intellectual disabilities had no schooling
and the figure was 50% for adults with hearing and vision impairment. It was 30% for
individuals with mobility impairment, reflecting the accessibility issues7. According to the
World Health Organization, the inclusion of children and adults with disabilities in education
is important for several reasons. Education contributes to human capital formation and is
thus a key determinant of personal well-being and welfare as well as development of the
community as a whole. Therefore, excluding children with disabilities from educational and
employment opportunities has high social and economic costs. Universal primary education
is a Millennium Development Goal as well as a child right, thus an indicator of quality of life
of a child in a country.8 Providing education opportunities for the children with disabilities is
therefore a social responsibility.
5 Ministry of Social Services, Sri Lanka (website) 6 Ministry of Education, Sri Lanka (website) 7National Social Policy, 2003 8World Report on Disability WHO, 2011
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There are several recognized approaches to educate children with disabilities. Special
schools and integrated schools which function as separate institutions or class rooms
recognize children with disabilities as a different social category. Discrimination issues
existing in the society may filter into these education systems, enhancing the negative effects
of the environment on children with disabilities. As it is practically impossible to have special
schools in all villages to cater for the few children in the community, the accessibility of a
disabled child to the education facility is further limited. Inclusive schools are schools in
which children with disabilities are in the same classrooms as other children. The education
system itself, and each school and classroom recognizes and responds to the diversity of
each child’s particular needs and abilities and respond to them by child centered teaching
methods. This concept is justified by the fact that most children with disabilities around the
world learn in “normal” schools (Figure 01).
Figure 01: Pupils with special education needs by category of need and type of setting in 20059
9 DG education and culture. Data source: OECD & CRELL
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Achieving the goal of inclusive education calls for multiple actions and coordination between
different sectors (Figure 02). Community involvement, including the involvement of parents of the
disabled children is also important.
Figure 02: Achieving Inclusive Education Goals10
This project attempted to explore the feasibility of achieving inclusive education for pre-school
children in Sri Lanka through phase I as described in the next chapter. A strategy for pre-school
inclusive education was developed and piloted in three selected DS divisions using the resource
materials developed by the project.
10 Adapted from: Inclusive Education Diagrams http://www.eenet.org.uk/resources/docs/diagrams.php
Inclusive Education
Motivation of teachers and other
stakeholders
Collaboration among agencies related to
education
Change of teacher training curricula
Use of local materials as
teaching aidsInvolvement of
local communities
Involvement of parents
Child centered education
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Implementation
The project was implemented in three districts, namely Anuradhapura, Batticaloa and Moneragala
(Figure 03). These districts were purposively selected on the basis of Plan Sri Lanka already working
in those districts.
Figure 03: Districts the programme was implemented and their populations11
Thus, the project covered a population of 1.83 Million, in the three districts belonging to three
different provinces (Eastern, Uva and North-central). The project was divided into four phases for the
11Department of Census and Statistics, 2014
Anuradhapura
856,232
Batticaloa
525,142
Monaragala
448,142
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purpose of implementation as described in Table 01. The methods used and findings of each phase
will be described in detail in the subsequent chapters.
Table 01: The actions implemented in the three phases of the project and utilized resources
Phase Objectives covered Actions implemented
I 1. To describe the
facilities for preschool
aged disabled children
to access preschool
services and quality of
services.
1. A resource person from the team visited the institutions
that provided education related services to the disabled
children in the 3 districts
2. Institutions were surveyed with regard to adequacy and
quality of services and good practices
3. Stakeholders were interviewed to explore their
perspectives on inclusive education
II 2. To develop
resource material for
training of pre-school
teacher trainers on
facilitating preschool
education for disabled
children.
1. Formulation of a working group
2. Development of a set of indicators to assess disabilities in
preschool aged children
3. Development of a screening tool kit to be used by the
preschool teacher based on the above indicators. An
instruction manual and a DVD with a video
demonstration was also developed
4. A list of 100 learning activities which is currently
recommended for preschool children were modified to
include children with disabilities
5. Development of a training manual for preschool teachers
on inclusive preschool education
III 4.To determine the
prevalence of
disabilities among
children aged 2-5 years
through a screening
process, in one DS
division in each of the
Districts
1. Recruitment and training of the data collectors
2. Pre-testing of the tool
3. Organizing screening sessions in Moneragala,
Madawachchiya and Oddamawadi DS divisions
4. Conducting screening sessions using the developed tool kit
5. Confirmation of the screened positive children by an
expert panel
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6. Referral of confirmed children for specialized care and
follow up.
7. Data management and analysis for documentation
IV 3. To train a core
group of practitioners
in 3 provinces as
specified by the Uva,
North Central and
Eastern ECCD
authorities/bureau on
how to train preschool
teachers using the
resource material.
1. Development of training curriculum
2. Planning and organizing the sessions
3. National level two day training of trainers workshop
4. Two regional level workshops in Batticaloa and
Anuradhapura districts
Except for phase IV, others were implemented parallel to each other whenever the activities of a one
phase are not dependent on the outputs of another, to ensure timely progression of the project
under the strict timeline.
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Phase I – Review of Existing Services
for Preschool Children with
Disabilities
Introduction
In Sri Lanka many state agencies and non-governmental organizations provide services to disabled
people, both adults and children, but these efforts are not well coordinated. This has contributed to
the lack of reliable data on the prevalence of disabilities.
Care for children with disabilities is provided to a great extent by their parents. This demands a lot
of time and other resources of the parents and might have an impact on the other children in the
family. Providing appropriate care for affected children early in their life is likely to enable them to
reach their full potential.
The estimated number of children with disabilities in the three districts – Anuradhapura, Batticaloa
and Moneragala is approximately 12 000, 8000 and 6000 respectively. This is based on the
assumption that the prevalence of moderate to severe disability among children under 15 years of
age is 5%.This review was undertaken to identify the institutional facilities available for children
(especially aged less than 5 years) in the selected districts and to document good practices.
Methods
Study setting – Selected schools and other institutions providing services to children with disabilities
in the districtsofAnuradhapura, Batticaloa and Moneragala
Study period – The District of Anuradhapura was visited in August 2013 and the Districts of Batticaloa
and Moneragala in October 2013.
Method of data collection- the selected institution was visited by an expert in the resource team.
The main data collection method was by interviewing key informants in the institutionsvisited.
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In each of the districts a wide spectrum of individuals ranging from provincial and district high level
officials to individuals caring for children with disabilities on a daily basis were interviewed.
Persons interviewed
Anuradhapura District
1. Deputy Provincial Director of Education / Special education
2. OIC / Special education resource center
3. Principal / Deaf and Blind School
4. Development Assistant / Department of Social Services – Provincial Directorate
5. Director / Early Childhood Education Development Authority
6. Manager/ Rajarata Participatory Development Foundation
7. OIC / Training school for children with learning difficulties, Nochchiyagama
Batticaloa District
1. Chairman / Preschool Education Bureau (PSEB), Eastern Provincial Council
2. General Secretary and CEO / YMCA Baticaloa
3. Principal / Vazhvosai – School for deaf children run by the YMCA
4. RDHS / Baticaloa
5. ISA / Special education
6. POIC / Probation Office, Batticaloa
7. District SSO / Social Care Center, Batticaloa
8. Principals of two ordinary schools admitting children with disabilities
Moneragala District
1. Acting Principal/ Deaf & Blind School, Kubukana, Moneragala
2. Members of an NGO working with disabled people
Results
Facilities for children under five years
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There were neither residential facilities nor preschools exclusively for children with disabilities in
none of the three districts visited. In none of the three districts children under five years with
disabilities were accepted by residential homes.
A private preschool (nonresidential) in Moneragala accepting children with disabilities was not
possible to be visited as the owners were reluctant to arrange a visit.
Most people interviewed were of the opinion that Sri Lankan parents are unwilling to admit their
young children with disabilities to residential facilities. Residential facilities for preschool aged
children are unlikely to be utilized by most parents.
The Early Childhood Education Development (ECED) authority or the Preschool Education Bureau
(PSEB), as the case may be, have data on the number of preschools in the district and the number of
students attending the preschools but they do not routinely collect data regarding children with
disabilities in the preschool age group. Whatever data available with these authorities are likely to
be gross under estimates as most of the children with disabilities are not enrolled in preschools.
Facilities for older children
The facilities available for older children with disabilities are –
1. Residential homes
2. Special schools (for resident and nonresident children)
3. Ordinary schools
Residential Homes
The two homes (one for females and the other for males) visited in the Anuradhapura District catered
to older children and young adults. Neither of these homes had specially trained resident staff. The
training and other facilities provided to the inmates was rather basic. The home for females was
being conducted as a charitable home for long term care rather than as a place for education/
training. The home for the males was slightly better in providing training to the inmates. One reason
for this could be the capacity of the inmates in the home for the males was probably slightly better.
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Special schools
The school for deaf children in Batticaloa and the deaf and blind school in Kubukana, Moneragala
had children aged from 5 years to 18 years. Both had trained teachers looking after the hostel
facilities and the school in Kubukana had visually handicapped teachers in its staff. Both institutions
had difficulty in maintaining a staff student ratio of 1: 5. There were some doubts about the
commitment of some of the teachers at the school in Kubukana to continue teaching in a school for
the deaf and blind.
One of the problems identified by the teachers in these schools and the principal of the deaf and
blind school in Anuradhapura was that the children on admission to school at 5 years lacked the social
skills expected at that age to attend school. None of these children had attended preschool and this
was probably the reason for the lack of social skills.
Ordinary schools
The two ordinary schools in Batticaloa that were visited had special class for children with disabilities.
Except one blind child in an ordinary class all other children with disabilities were in special classes.
The main reason for this was the shortage of teachers. The staff in these schools considers this as a
form of inclusive education. One of the schools had many children with disabilities travelling by
trishaws funded by an NGO dropping out recently as the funding for transport had been discontinued.
It was felt that arranging transport and admitting the siblings to the same schools as two important
factors promoting schooling of children with disabilities.
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Phase II – Development of Resource
Materials for Inclusive Preschool
Education
Introduction
The concept of inclusive education is a broad concept. It can involve many different special social
categories such as orphaned children, street children etc. Inclusive education for children atpre-
school age will help to improve their opportunities to attend to schools with inclusive education,
enhancing their potential. To develop an inclusive education system requires many effort and
investments at the initiation. In Sri Lanka, where there are minimal initiatives for inclusive education,
there is a great need for resource materials in the subject. This need was confirmed during the key
informant interviews of phase I. This phase attempted to cater to that need by developing resource
materials to improve capacities of the preschool teachers.
Methods
A multi disciplinary working group was formed with experts from various specialties of child health
and public health. The resource persons in the working group with their respective specialties are
mentioned in Annex A. The working group was assigned the following tasks.
1. Development of indicators to assess disabilities in preschool aged children
2. Development of a tool kit to be used by the preschool teacher to screen the children for
disabilities.
3. Modify the 100 learning activities currently recommended for preschool children to include
children with disabilities
4. Development of a training manual for preschool teachers on inclusive preschool education
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This phase, probably the longest, lasted throughout the total project period. Working group met 5
times for collaborative sessions to fulfill the assigned tasks. Local and international literature was
perused and local experts from the relevant fields were consulted. Main aim of the working group
was to develop practical and feasible methods to incorporate principles of inclusive education to the
current early childhood education (preschool) system.
Results
1. Indicators to assess preschool children for disabilities
A set of indicators were developed based on the international and local guidelines and screening
tools under the themes of gross motor and mobility; fine motor and coordination; social and
emotional development; cognitive development; hearing, language and communication
development. The resource persons from the respective specialty tabled a set of indicators based on
literature and the working group collectively selected the ones to be incorporated in to the tool. The
criteria used to select the indicators are listed in Box 01.
The selected indicators for each age group are annexed in Annex B. Except for hearing assessment
indicators, other indicators were grouped together to improve the feasibility of application including
time spent on a child and ensure smoothness of the flow.
Box 01: Criteria used to select theindicatorsfor screening preschool children
1. The importance – how important is the indicator in assessing the
relevant disability
2. Discriminative ability – ability of the indicator to discriminate a child
with disability from a normal child
3. Feasibility of application – practical aspects of applying it at a
preschool setting
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The developed list of indicators were incorporated into the preschool teacher trainer manual on
inclusive education and training curriculum of the national and regional level TOT programmes and
disseminated to the target group.
2. The tool kit to screen preschool children for disabilities
A tool kit was developed to screen the preschool children for disabilities based on the developed
screening indicators. The kit included a set of objects that can be easily found in the local market, an
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instruction manual developed in Sinhala and Tamil languages and a DVD with a video demonstration
on application of the tool kit. The list of objects needed for the tool kit is mentioned in Box 02.
The estimated cost of a tool kit is around LKR 2500, ensuring affordability for replacing the items or
duplicating the whole toolkit if required at a rural preschool setting.
The tool kit is comprised of easy to apply, simple activities as illustrated in the photographs below.
Box 02: Objects of the tool kitfor screening preschool children
1. 18 cubes (1 inch size)
2. 2 Jumbo crayon packs
3. 1 Board book
4. 2 Clay packs
5. 1 Peg board with shapes (circle, square, triangle, diamond/rectangle)
6. 5 balls of different sizes (12 inch, 8 inch and, 6 inch, 4 inch and 2 inch)
7. 10 Cylinders (2 inch tall, 2 inch diameter)
8. 2 large containers with 4 inch screw cap
9. 1 Tea set
10. 1 set of 4 piece puzzle
11. 10 large beads with large holes
12. A shoe string
13. 2 Safety scissors(medium size)
14. 1 set of 5 piece puzzle.
15. 4 small balls each in blue, green and red colours
16. Blue, green and red containers (to put the above balls in matched colours)
17. 1 Toy truck
18. 1 doll
19. 1 toy car
20. 1 Bottle with small mouth
21. 1 packet of beads to put in the above bottle (size of a ‘pop-it’)
22. 1 Bundle of half-sheets
23. Pictures and printed materials as mentioned in the instructions guide
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The developed tool was pretested and used in Phase III of the study to determine the prevalence of
disabilities in preschool children aged 2 to 5 years. The tool was introduced to the preschool teacher
trainers and other stakeholders in the national and regional level TOT workshops and included in the
training manual to the preschool teachers on inclusive preschool education. Sample tool kits were
distributed among the preschool teacher trainers and selected preschools by Plan Sri Lanka.
The screening tool was also presented at the 127th International Medical Congress of Sri Lanka
Medical Association held at Colombo in August 2014, with the aim of sharing it with the scientific
community of the country.
3. Learning activities to include children with disabilities
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The next task of the working group was to modify the recommended learning activities in the
“PeraLamaviyaSanvardhanayasahaAdhyapanay;, IgenumKriyakarakamSangrahaya” published by
Plan Sri Lanka to include children with special needs. Two workshops were held at the Faculty of
Medicine, University of Kelaniya to fulfill this responsibility. A set of general guidelines (Box 03) were
developed that can be useful to the preschool teacher in incorporating children with disabilities to
any learning activity.
Box 03: General guidelines to preschool teachers in including children with
disabilities to learning activities
1. Make sure that all children are included in the activities.
2. Think creatively of ways to include children with disabilities and be sensitive about
discrimination based on difficulties
3. Talk to the parents/guardians about the child’s condition and abilities and difficulties
and modify activities accordingly to include them.
4. Pay extra attention to safety of the participating children with disabilities
5. Always show appreciation of the child’s participation regardless of how well (s)he does it
as these activities will contribute towards building the self-esteem of the child.
6. Some children may need more time to complete tasks.
7. Simplify instructions and demonstrate actions whenever possible. Use lots of gestures
and clear articulation with pauses.
8. If there is a child with a hearing disability, place him/her in front of the class so that
(s)he can see the teacher’s face well and read lips. They will find it difficult to hear the
instructions when there is a lot of background noise. For example, if children are
shouting.
9. Some children may need more physical support, verbal prompting and visual cues to
help them understand instructions and carry them out.
10. Some children may need tools adapted according to their abilities/difficulties
11. If you notice a particular activity will distress the child, try to avoid it. For example, if
clapping and cheering distresses a child, find an alternative way to show
appreciation/reward (thumbs up/waving a flag).
12. Some children may find it difficult staying on a task for a long period. Get them to
participate at least briefly and praise their efforts. Allow them to come back if they like.
13. Some children may find it difficult to draw and colour. Encourage them and praise their
attempts.
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The each and every activity of the recommended 100 learning activities was analyzed with regard to
find opportunities to include children with disabilities in them. Some activities were recommended
to be carried out as they are using the teacher’s innovativeness to include children with disabilities
but specific modification guidelines were given to a majority of activities. The Table 02 summarizes
the modifications recommended to the list of activities.
Table 02: The summary of modifications to the recommended learning activities
Activity Group1 Recommendation Activities1
Activities to
develop physical
skills (5.1-5.20)
Activities that do not need specific
modifications
none
Activities that need specific modifications 5.1 – 5.20 (all activities)
Activities that cannot be recommended none
Activities to
develop personal
and social skills
(6.1-6.34)
Activities that do not need specific
modifications
6.4, 6.7, 6.9-6.16, 6.18, 6.20,
6.21, 6.23, 6.27-6.32, 6.34
Activities that need specific modifications 6.1-6.3, 6.5, 6.6, 6.8, 6.17,
6.19, 6.22, 6.24, 6.33
Activities that cannot be recommended none
Activities to
develop
communication
skills (7.1-7.21)
Activities that do not need specific
modifications
none
Activities that need specific modifications 7.1 – 7.21(all activities)
Activities that cannot be recommended none
Activities to
develop creativity
and easthetic
appreciation (8.1-
8.24)
Activities that do not need specific
modifications
none
Activities that need specific modifications 8.1 – 8.24 (all activities)
Activities that cannot be recommended none
Activities to
develop critical
thinking and
problem solving
skills (9.1-918)
Activities that do not need specific
modifications
none
Activities that need specific modifications 9.1 – 9.18 (all activities)
Activities that cannot be recommended none
1coded as the original document
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As explained in the table, the work group found no activity that should be excluded. Thus, all the
learning activities currently used and familiar to the preschool teachers can be used in an inclusive
preschool also. This will improve the feasibility of training preschool teachers and their trainers as
well as developing the current early childhood education system in Sri Lanka to incorporate inclusive
education concepts. The modified activity list was incorporated in to the training manual developed
under the project with illustrations explaining difficult concepts. Some of the activities were
demonstrated in the national level TOT programme to introduce and familiarize the preschool
teacher trainers to the concept of inclusive education.
4. A training manual for preschool teachers on inclusive preschool education
A training manual was developed by the working group to use as a resource in training preschool
teachers. The manual comprised of nine chapters including an introduction chapter that introduced
the concepts of disabilities in childhood and inclusive education. Second chapter contain norms of
development in children from birth to five years in the domains of gross motor, fine motor, social,
emotional and speech, language and hearing development. Subsequent chapters are dedicated to
provide an overview to the different types of disabilities and tips of class room management. Physical
disabilities; social and behavioural problems; learning disorders; hearing impairments and speech
and language difficulties are the different types of disabilities that are discussed. A chapter on
medical conditions commonly found in preschool children with disabilities was also included to
improve the comprehensiveness of the manual. Final chapter contains the recommended
modifications to the learning activities to include children with disabilities in the classroom. A list of
indicators that can be used to assess the development of children in preschool age and some
examples of commonly used adaptive devices were annexed at the end.
Written in simple manner and published in both first languages in Sri Lanka, it can also be used as a
classroom guide by the preschool teacher. The training manual is now at the final stage of printing
process and when completed, it will be distributed among the preschool teacher trainers and
teachers by Plan Sri Lanka.
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Phase III – Prevalence of Disabilities
in Preschool Aged Children
Introduction
A systematic and ongoing data collection system to collect data on disabilities is not in function in Sri
Lanka. Some questions are asked at the census that is conducted in once in 10 years and self reported
data is obtained to calculated prevalence of types of disabilities according to the different age groups.
The disability related data from 2012 population and housing census is still not published. In 2001
census, in which only data from 18 districts were included, Department of Census and Statistics state
that 4851 children in the age group of 0 to 4 years are disabled. Out of the disabled children in that
age group, the higher proportion is seen among the male children, which is 57.4%. The numbers seen
in each disability type in the 2001 census is presented in Table 0312.
Table 03: Number of children aged 0-4 years with disabilities in each disability type12
Total
Number
Disability in
Seeing
Disability in
Hearing/
Speaking
Disability in
Hands
Disability in
Legs
Other
Physical
disability
Mental
Disability
Male 2783 323 1212 536 1078 378 733
Female 2068 309 910 340 729 309 578
Total 4851 632 2122 876 1807 687 1311
World Report on Disability estimates the prevalence of moderate to severe disabilities among the 0-
14 years age group as 5.2%. In the same report, the estimated prevalence rate for Sri Lanka for all
age groups was 12.9%. It was around 6 times higher than the 1.6% reported from the population and
housing census in the year 2001.Thus the need to determine the rates of different disabilities among
the pre-school children is justified.
12 Department of Census and Statistics, 2001
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Methods
Study design: A community based cross sectional study
Study setting: A Divisional Secretary (DS) division each was purposively selected from the selected
districts. The selected DS divisions are stated in the Table 04 with the respective populations.
Table 04: Divisional Secretary divisions selected from each district and the population
District DS division Population1 Estimated number of
eligible children2
Anuradhapura Madawachchiya 46,743 2750
Batticaloa Oddamawadi 22,144 1450
Moneragla Moneragala 49,631 2450
Total 118,518 6650
1Department of Census and Statistics; 2Local MOH office
Study population:All the children in the selected DS divisions aged 2 to 5 years (children who have
completed the 2nd birthday but yet not completed the 5th)
Study sample: All the eligible children were invited for participation through area public health
midwife and the preschool teachers. Therefore a sample size was not calculated and sampling was
not done. The number of children estimated in each DS division is mentioned in Table 04.
Data collection: The screening tool developed in phase II was used to screen the recruited children
for disabilities. The tool was pretested in a preschool randomly selected from Ragama MOH area.
Fourth year medical students, pre-intern medical students and graduates of BSc degree programme
in speech and hearing sciences were recruited and trained to apply the tool. The screening sessions
were scheduled with the support and coordination of field health staff and the Plan Sri Lanka field
staff in the respective settings to improve the participation. The children were invited to come to a
place well known to them, the local preschool, the clinic center or the weighing post. Socio-
demographic details and past medical history was obtained prior to application of the tool after
obtaining consent from the caregiver. Any child who was not able to complete any of the activities in
the relevant age group was considered as a “screened positive” and was referred to a confirmatory
session in a subsequent day.
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A multi disciplinary expert panel visited the selected area after all the screening sessions were
completed and examined the referred children. The expert team comprised of the specialists in
pediatrics, child psychiatry, physiotherapy, occupational therapy, audiology and speech therapy. A
team of supportive medical officers and clerical staff also travelled with the team to support the
process. Necessary steps were taken to ensure the confirmed get the available optimal management
and rehabilitation services after confirming the disability.
Data analysis: Epidata data management software was used to enter data and data were analysed
using SPSS statistical analysis package. Descriptive statistical methods were used to calculate and
present the prevalence rates.
Results
Overall response rate for the whole study population was 69%. The participation rates differed
according to the DS division as illustrated in Table 05.
Table 05: Number and percentage of eligible children screened in each DS division
District DS Division Estimated number of
children (2 to 5 years)
Children screened
No %
Anuradhapura Medawachchiya 2750 1864 68%
Batticaloa Oddamawadi 1450 863 60%
Monaragala Monaragala 2450 1838 75%
Total 6650 4565 69%
The lowest participation was from Oddamawadi DS division and it was 60% of the estimated number
of eligible children. Other two DS divisions showed a satisfactory level of participation around 70%
of estimated children.
Socio-demographic profile of the screened children is described in Table 06.
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Table 06: Socio-demographic characteristics of the screened children
Socio-demographic
characteristic
Madawachchiya
(%)
Oddamawadi
(%)
Moneragala
(%)
Total
(%)
Total screened 1864 (41) 863 (19) 1838 (40) 4565
Sex
Male
Female
913 (48.9)
951 (51.1)
435 (50.4)
428 (49.6)
899 (48.9)
939 (51.1)
2247 (49.2)
2318 (50.8)
Age
2+
3+
4+
626 (33.6)
630 (33.8)
607 (32.6)
175 (20.3)
208 (24.2)
479 (55.5)
601 (32.7)
584 (31.8)
653 (35.5)
1402 (30.7)
1422 (31.2)
1739 (38.1)
Low birth weight 335 (18.0) 181 (21.0) 353 (19.2) 869 (19.0)
Consanguinity 97 (5.2) 32 (3.7) 101(5.5) 230(5.0)
Reception of SCBU
care
364 (19.5) 122 (14.1) 298 (16.2) 784 (17.2)
Around 15% of screened children were referred and participation rates were around 50%to the
expert panel assessment as presented in Table 07.
Table 07: Referral rates for the expert panel session and participation of the screened children
DS Division No of
children
Screened
Children Referred to the
expert review
Children participated to the
expert review
No % No %
Medawachchiya 1942 287 14.8 159 55.4
Oddamawadi 863 107 12.4 51 47.7
Monaragala 1782 277 15.5 120 43.3
Total 4587 671 14.6 330 49.2
Out of the screened positives, around 82% were confirmed as having some form of disability by the
expert panel. Thus, predictive value of a positive screening test for the developed tool was 82%. Out
of the children who participated, a majority with obvious disabilities were already being identified
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and followed up by the health care services. The newly diagnosed cases were mild conditions that
had a great potential for improvement with interventions at household and preschool levels.
Due to the low participation rates for the expert panel reviews, the prevalence rates were adjusted
for non response to improve the validity of the estimates. The overall adjusted prevalence rate was
121 per 1000 preschool aged children. The adjusted prevalence rates for the different disability types
are mentioned in the Table 08.
Table 08: Adjusted prevalence rates for 1000 preschool aged children
DS Divisions Multiple
Disabilities
Physical Psycho-
social
Hearing Speech
Medawachchiya 52 4 39 10 20
Oddamawadi 34 19 19 7 19
Monaragala 27 19 30 16 43
Total 39 13 32 12 30
Proportion of confirmed children with each type of disability is illustrated in Figure 02.
Figure 02: Proportion of confirmed children with the type of disability
As presented in Figure 02, a majority (one out of three confirmed children) had multiple disabilities.
Most children of this category had global developmental delay with learning difficulties and
32%
26%
9%
23%
10%Multiple disabilities
Psycho-social
Hearing
Speech
Physical
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behavioral problems. Psycho social disabilities came second indicating that most of the children with
disabilities may need attention and support in this aspect as a majority with multiple disabilities also
had them.
The distribution of disability types according to the DS divisions are illustrated in Figure 03.
Figure 03: Percentage distribution of each disability type according to the DS division
Physical disabilities were highest among the children in Oddamawadi DS division and the rate was
doubled than the rate in the total population. Speech and hearing impairments were highest in
Moneragala DS division and psycho-social problems were highest among children in Medawachchiya
DS division.
Limitations of the study
There are certain limitations of this phase that needs to be discussed. Not doing home based
screening may have limited the access to the children with major disabilities to the screening
sessions. However the effects of this may have reduced by the fact that investigators took all the
measures possible to actively recruit such children to the screening sessions. Local health workers’
41.5
31.1
19.5
11.5
31.7
32.5
26.1
9.3
22.5
9.6
0.00 10.00 20.00 30.00 40.00 50.00
Multiple disabilities
Psycho-social
Hearing
Speech
Physical
Total
Moneragala
Oddamawadi
Medawachchiya
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help was obtained in identifying those children and transport facilities were provided when
necessary.
Low participation rates for the confirmation by the expert panel may have reduced the accuracy of
the estimated prevalence rates. As explained in the results section, a majority of confirmed cases had
obvious deformities. Thus a notable proportion of non participants may have mild, less obvious
conditions that are missed by the caregivers. The stigma associated with the review sessions as local
communities got to know that they had been held to identify “disabled children” may have prevented
the parents who think their children as “normal” from bringing them to the review session.
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Phase IV – Dissemination of Results
and Training of Trainers on Inclusive
Preschool Education
Introduction
Inclusive preschool education is a new concept to the Sri Lankan early childhood education system.
Thus there is a wide gap of knowledge, attitudes and skills to be fulfilled if to introduce the concept
to the current system. The main aim of phase IV was to train a core group of teacher trainers including
preschool teachers on principles and methods of inclusive preschool education. This phase also
targeted to disseminate the study findings and the recommendations among the stake holders to
promote a conducive environment to convert them to practice.
Methods
Three main methods were used to achieve the objectives stated above.
1. Presenting the research findings at 127th International Medical Congress of Sri Lanka Medical
Association (SLMA)
2. National level and regional level training of trainers workshops
3. Training manual for the pre-school teachers
Results
1. Dissemination of findings
A pre congress session of the 127th International Medical Congress of Sri Lanka Medical Association
(SLMA) was organized with the collaboration of Plan Sri Lanka and SLMA committee on disabilities.
Stake holders from the scientific community, medical professionals, education officials, officials from
social services, representatives from other government and non-government organizations
interested in education of disabled children participated in the session. The findings were also shared
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in all training of trainer workshops conducted under the project to improve the awareness of the
participants about the existing situation.
2. Training of teacher trainers
Three teacher trainer workshops were conducted by a resource team to achieve this objective at
national and regional levels. The details of those workshops are presented in the Table 09.
Setting Level Number of participants
Colombo National 35
Moneragala Regional
Anuradhapura Regional
A comprehensive guide on childhood disabilities and inclusive preschool education was developed
under phase II as described earlier. It will contribute to improve the knowledge and awareness of
preschool teachers and their trainers who did not get the opportunity to participate in the training
sessions conducted by the resource team.
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Conclusion and Recommendations
Preschool education facilities for children with disabilities needs to be improved in Sri Lanka. Project
recommends the following;
1. Build capacities of preschool teachers and trainers to include children with disabilities in
classroom activities. The training manual developed by the project can be used as a resource
material.
2. Build capacities of preschool teachers and primary health care providers to identify children
with disabilities to effectively interact with them and refer them to necessary institutions to
improve their limitations. The easy to use screening tool developed by the project can be
used for the purpose and teachers and service providers can be trained to interpret the
findings and refer accordingly.
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Annex A: The multidisciplinary
working group in Phase II
Resource person Specialty
1 Prof. AR Wickremasinghe Public health
2 Dr. C Jayasinge Paediatrics
3 Dr. L Wijeratne Child psychiatry
4 Dr. S Hettiarachchi Speech and language sciences
5 Ms. P Godamunne Child psychology
6 Dr. KMN Perera Community Medicine
7 Ms. R. Fonseka Audiology
8 ThiliniLokubalasuriya Speech and language sciences
9 GayathriSivasubramaniyam Speech and language sciences
10 EranthiChathurika Audiology
11 BandiniJayasena Audiology
12 WasanaDahanayake Occupational therapy
13 NeluniSamarasekara Physio therapy
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Annexure B– Indicators to Assess
Developmental Delay in Pre-School
Children
Part 1
Screening questionnaire for motor, cognitive,
emotional and speech and language skills
The indicators are shown according to the age groups
Two years (24 months to 35 months)
Achieved Not achieved
1.1 Can walk back two steps
1.2 Can run after a ball
1.3 Can make tower of 3 blocks
1.4 Can draw a line
1.5 Can turn a page
1.6 Can make balls out of clay
1.7 Responds to name
1.8 Can point to an object
1.9 Can show head and nose
1.10 Knows 50 or more words
1.11 Can put two words together
1.12Can place correct shape in a board
1.13 can show the bigger of two objects
1.14 Can group objects
1.15 Will look when you point
1.16 Imitates making tea
1.17 Shows favourite
1.18 Pronunciation (Pronounces following sounds
correctly)
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Pa
Ba
Tha
Da
Ma
Na
Three years (36 months to 47 months)
Achieved Not achieved
2.1 Can climb up 3 stairs one foot at a time without help
2.2 Can run safely avoiding obstacles
2.3 Can catch ball
2.4 Can throw ball over head
2.5 Can assemble 4 piece puzzle
2.6 Can copy circle
2.7 Can make a tower of 8 blocks
2.8 Can put 3 beads on a shoe lace
2.9 Can open bottle
2.10 Can cut with scissors
2.11 Understands simple commands of three words
2.12 Can describe picture using sentences
2.13 Can use past tense
2.14 Can ask questions
2.15 Can match primary colours
2.16 Can count to 3
2.17 Can identify emotions
2.18 Can choose one
2.20 Can play using make believe
2.21 Can identify whether boy or girl
2.22 Can answer questions
2.23 Can say "NO"
2.24 Can use pleural words
2.25 Pronunciation (Pronounces following sounds correctly)
Pa
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Ba
Tha
Da
Ma
Na
Ka
Ga
Ha
Sa
Cha
Ja
Ya
Child’s pronunciation is clear to the family members
Four Years (48 months to 59 months)
Achieved Not achieved
3.1 Can run, stop , turn and run back
3.2 Can hop using one foot
3.3 Can balance on one foot for 8 seconds
3.4 Can catch ball and throw back
3.5 Can jump off step
3.6 Can make steps with 10 blocks
3.7 Can cut out circle
3.8 Can copy signs
3.9 Can put 20 pellets into bottle
3.10 Responds correctly to two step commands “catch ball and throw back”
3.11 Can retell a story with pictures
3.12 Can sing several nursery rhymes
3.13 Can name primary colours
3.14 Can identify the odd one
3.15 Can complete pattern
3.16 Can sort objects according to size
3.17 Will help someone
3.18 Can take turns
3.19 Says can do
3.20 Describes the use of an object
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What is used to sweep the floor?
What is the use of a broom?
3.21 Pronunciation(Pronounces following sounds correctly)
Pa
Ba
Tha
Da
Ma
Na
Ka
Ga
Ha
Sa
Cha
Ja
Ya
Ta
Dha
Ann
Pronunciation is clear
Five years (61 months upwards)
Achieved Not achieved
4.1 Can stand on one leg for 10 seconds
4.2 Can jump on and off a step
4.3 Can climb up and down stairs without help changing feet
4.4 Can walk backwards for 1 metre
4.5 Can connect dots and complete and picture
4.6 Can make pyramid out of 6 blocks after demonstration
4.7 Can hold pencil correctly
4.8 Can cut shapes and paste
4.9 Can copy a triangle
4.10 Can understand a 3 step command
4.11 Can express most of the sounds correctly
4.12 Can put 4 picture cards in correct order for the story and retell it
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4.13 Can tell the complete name and age correctly
4.14 Names animals, fruits and vegetables; at least three items in each
4.15 Can draw a man
4.16 Can count upto 10
4.17 Able to say right from wrong
4.18 Can identify emotions
4.19 Can describe one situation that give rise to similar emotions
4.20 Can name relationships
4.21 Can identify differences
4.22 Pronunciation - Child’s pronunciation is clear to the family, friends or others.
Part 2
Screening questionnaire for Auditory Skills
These can be used to screen children who have completed two years upto five years of
age
General Questions
Yes No
1. Does/did anyone in your family has/had a hearing problem?
2. Does/did your child has/had any ear complications?
Earache
Ear itching
Ear discharge
Medication for ear
3. Does your child ask for repetitions?
4. Did your child have any attacks of measles/mumps/meningitis?
5. Do you suspect a hearing loss in your child?
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Auditory Skills
Discrimination Yes No
8. Does your child recognize mother’s voice from father’s voice?
9. Is your child able to distinguish words such as;
Bole/kochchiya
Gaha/ Sapaththu
Mala/ Satha
Identification Yes No
10. Does your child identify the following when they are heard?
Dog- bow bow
Cat – meowww
Train – kuchukuchu
Cow – umbaa
11. Does your child identify his/her name when called?
Comprehension Yes No
12. Ask child to repeat these four words in order
Balla
Pusa
Aliya
Hava
13. Does your child understand most of what is said through audition alone without any visual or gestural cues?