Developing an Inclusive Education & ECD Strategy...5 About the report This report is the final submission to Plan Sri Lanka, by Faculty of Medicine, University of Kelaniya on the project

0

AXCVH ACVBMJUYTRSZ KMJN B B

FACULTY OF MEDICINE UNIVERSITY OF KELANIYA

Developing an Inclusive

Education & ECD

Strategy

Final Report

1

The report was compiled by:

K Manuja N Perera

A Pathmesweran

A R Wickremasinghe

2

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

3

The List of Contributors

Prof. AR Wickremasinghe

Department of Public Health

Faculty of Medicine, University of Kelaniya

Prof. A Pathmeswaran



Dr. LeenikaWijeratne

Department of Psychiatry


Dr. ChamilkaJayasinghe

Department of Paediatrics


Dr. AnuradhiniKasthuriratne



Dr. ShyamaniHettiarachchi

Department of Disability Studies


Ms. PavithraGodamunne



Ms. RenukaFonseka



Dr. Manuja Perera



Ms. DeepaniSiriwardhana



Ms. WasanaDahanayaka

National Rehabilitation Hospital

Ragama

Ms. NelunikaSamarasekara

National Rehabilitation Hospital

Ragama

ThiliniLokubalasuriya



GayathriSivasubramaniyam



EranthiChathurika



BandiniJayasena



ChinthikaPerera



LakshikaUdugama



4

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

5

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.

6

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.

7

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

8

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

9

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

10

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

11

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

12

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

13

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.

14

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.

15

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

16

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.

17

18

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.

19

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

20

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

21

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

22

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

23

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

24

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.

25

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)


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 to

develop

communication

skills (7.1-7.21)


modifications

none

Activities that need specific modifications 7.1 – 7.21(all activities)


Activities to

develop creativity

and easthetic

appreciation (8.1-

8.24)


modifications

none



Activities to

develop critical

thinking and

problem solving

skills (9.1-918)


modifications

none



1coded as the original document

26

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.

27

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

28

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.

29

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.

30

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

31

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

32

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

33

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.

34

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

35

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.

36

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.

37

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

38

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)

39

Pa

Ba

Tha

Da

Ma

Na

Three years (36 months to 47 months)


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

40

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)


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

41

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)


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

42

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?

43

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?

Documents

Developing an Inclusive Education & ECD Strategy...5 About the report This report is the final submission to Plan Sri Lanka, by Faculty of Medicine, University of Kelaniya on the project