ࡱ> jli Y=bjbj T3;3 114)))h,4)]E(M$>$$ DDDDDDD$?HJJE(##|((E11E3-3-3-(p18RD3-(D3-3-\@i"0DPe)1)0CjD-E0]EC+K%*>+K0D+K0D$%3-&|&($$$EEc,$$$]E((((+K$$$$$$$$$ :  Submission by the Developmental and Community Paediatric Special Interest Group of the Paediatric Society of NZ Review of Special Education The Paediatric Society of New Zealand has a membership of 455 child health professionals from a range of disciplines including paediatricians, nurses, occupational therapists, pharmacists, physiotherapists, psychologists, speech language therapists and others. The Child Development and Community Paediatric Special Interest Groups have 83 and 87 members respectively. The Paediatric Society of New Zealand requests the opportunity to make an oral submission. The three main points of this submission are: Special Schools are needed for some children with very significant disability who would not be able to function in mainstream classes, for example those with severe intellectual disability, severe physical disability, or those with autism spectrum disorder and challenging behaviour. There is a need for training of teachers (and health professionals) at all levels in all aspects of assessment and education of children and young people with special needs. This should start during undergraduate training, and continue throughout a persons working life as ongoing professional development. Such training provides opportunities for health and education to work and learn together. Training is also essential for paraprofessionals. The almost total lack of formal cognitive assessment within education is a critical issue. Formal cognitive assessment is necessary in order to fully understand a significant proportion of children presenting with learning delays and or behavioural issues. Cognitive assessment should no longer be restricted to a minority of children with the most severe behavioural problems. Other important issues include: The success of inclusion in individual schools depends in a large part on the principal, but the training, experience and knowledge base of all teachers is important and needs addressing. Successful inclusion is not a cheap option. Verification for ORRS funding is problematic, with a high skill level needed to apply successfully. Work is needed on all key transitions in a childs education and then working life. The need for special schools The options discussed range from keeping the status quo to closing special schools and reallocating the staff. As community and developmental paediatricians and allied health professionals, we are very aware both of the benefits of inclusion for most children with special needs. However, there are some children who are unable to function successfully in mainstream schools in the current system. For these children, Special Schools or classes with their high level of experienced staff, and their highly differentiated individualised and adapted educational plans, are essential. In our view the case for special school provision, including satellite classes, is strongest for those children and young people with severe intellectual disability, and for many of those with autism and associated very challenging behaviour, and for those with severe physical disability and very high medical and physical needs. The provision of successful inclusion for every child would require substantially more investment of resources in training teachers and paraprofessionals, and substantially more funding for paraprofessional support. It is not appropriate for those children with the highest level of educational need to receive most of their educational input from people with minimal training (ie Educational Support workers/Teacher Aides). If a goal of full inclusion is to be achieved, a detailed plan of how to achieve this, with provision of necessary resourcing would be required. This would require a programme over years, as entrenched attitudes in some schools cannot be changed quickly. We acknowledge that considerable progress has been made since 1989, but there is still much work to be done. As child health professionals, we are all too often asked to prescribe medication to control a childs behaviour, because of concerns about the safety of other students and staff at a school. Such treatment is not necessarily in the best interests of the child with special needs, and may be harmful. What makes for successful inclusion? Schools vary widely in their willingness to have students with special needs, and in their expertise to offer appropriate support. Schools that welcome children with special needs and do a very good job for and with them become magnet schools, which must place a large burden on staff time and on school budgets. Successful inclusion is more likely where the Principal is very motivated to make it work. However, levels of knowledge of different special needs vary between teachers even within a single school. Successful inclusion is not a cheap option. Children in mainstream schools are often, in our experience, significantly under-funded, or staff lack the knowledge and skills to make integration work optimally. For example, a recent paper on New Zealand school children with physical disability found that Of particular note was the proportion of children who had difficulties joining in games and sport at school (59%), going on school outings or camps (28%), playing at school (47%), and or making friends (35%). In all, an estimated 67% of children had one or more problems taking part at school (Reference 1). Another example of an unmet need for those in mainstream schools: many children would benefit from speech language therapy and social skills training, but therapists and funding are in short supply and many children simply do not qualify under the current criteria. Training of teachers and other school staff: provision to children with special needs a core component of any teaching degree We recommend that all teachers in training should be required to take a compulsory paper or part of a paper on children with special needs. The content of the paper would need to be developed, but could include information on intellectual disability, specific learning difficulties, autism and Aspergers, and ADHD. Some general approaches to evaluation and programme development could be taught, as well as a full description of the different support services available within Education, but also within Health. Health (eg doctors, Public Health Nurses) could be involved in the teaching. Health professionals could also be involved as recipients of ongoing professional development around these topics. Such ongoing professional development would provide opportunities for school and health staff to work and learn together. Improved training of the SpecialEducation staff including the Special Education advisors and the RTLBs is required.There have been two EROreviews of the RTLB service, in 2004 and 2009 (references 2 and 3) both of which have been critical of the management structure, the consistency of service delivery and the level of training of the RTLBs. In these reports, it was noted that many RTLB do not have an effective practice. Typically, these RTLB do not collect valid assessment data, have a menu approach to interventions, and do not monitor the impact of their interventions . The results suggested that current processes for appointing, training, supervising and appraising RTLB required significant changes to increase the level of assurance about the quality of RTLB practice nationally. As alarge proportion of the special needs budget goes into the RTLB service, having thisservice functioning effectivelyseems essential. Cognitive assessment At present many educators and parents are confused and lack a true understanding of why their child is struggling and or failing to perform. This is because assessments tend to be strengths based, relating what the child can do. Such assessments cannot differentiate between a child with a generally low cognitive ability and a child with normal intellect but a specific reading problem. Similarly, children with behaviour problems who are failing at school may be unable to follow the lesson because of cognitive problems, but they may be of normal intellect with good academic potential but have a particular problem concentrating and staying still and on task (ADHD). Formal psychometric testing is needed in these situations. It allows programs to be developed that truly address the individual childs needs. Education needs to now accept that special needs children cannot all be adequately provided for without such formal testing. ORRS verification Schools vary in their experience and success in applying for ORRS funding. Professionals who are more skilled in writing applications are more likely to be successful, which is unfair. Transitions Transitions are difficult times for the child and the family. Transition into school can go well for children already under an early intervention team but many children do not attend early childhood education and therefore arrive in school with problems unrecognised and perhaps masked or made worse by English as a second language. Readily available and affordable ECE is an ongoing need. Families often have little or no information on what options are available for their child eg which local schools have learning support units, where local special schools are and what areas each school tends to specialise in. Even when information is available, parents generally lack guidance on which option to choose. Transition from one school to the next, and from school to work or productive leisure are difficult times too. Schools need to be able to adapt the curriculum for young people with special needs, so that for example secondary school pupils can learn skills that prepare them for life as competent adults. This may mean teaching a student to catch a bus rather than insisting the all students learn a second language. We are aware of teens still struggling with the rudiments of English who are being asked to learn Japanese. At the same time as young people leaving school or full time education, they are often also leaving the care of their Paediatrician. Paediatric services generally stop seeing children when they turn 18. The NASC agencies have an important role where their clients are moving on from school, and these NASCAs remain involved until the client turns 65. Good information sharing by Health, Education, and NASC agencies could make the transition into work smoother. Better support and medical and mental health services for adults with disabilities are needed and are often sadly lacking. Service Co-ordination and the Health Education Interface Many children with special needs require consistency of approach across all settings especially home and school. This means that, for example, the therapy approach needs to be implemented in both settings for the child to gain optimal advantage. Even more pertinent is the need for application of behavioural strategies across settings. At present children may receive different services for the same problem through health and education. This is inefficient use of resources and may indeed be ineffective. The education system employs a number of health professionals; in particular therapists are employed in a number of educational settings. In a large school for children with physical disability there will be a critical mass of therapists so that collegial support and professional supervision are readily available. However, in most educational settings therapists work in relative isolation making the maintenance of professional standards and collegial support difficult. We are of the opinion that therapists would be more appropriately employed in the health system. There are many examples of health professionals working effectively in schools, while employed in the health system. For example, Public Health Nurses in New Zealand and therapists in many other jurisdictions. Lastly, decisions made in the Education sector can have unintended consequences for service demand in the Heath sector (and vice versa). These issues have been present for many years and we would welcome discussion with a view to finding workable solutions. This submission was prepared by Dr Phillipa Clark, Chair of the Child Development Special Interest Group of the Paediatric Society of New Zealand, with contributions from member of the Child Development and Child Community Health Special Interest Groups on behalf of the Paediatric Society of New Zealand. It is endorsed as a Position Statement reflecting the views of the Paediatric Society of New Zealand membership. References 1. Clark P. Macarthur J. Children with physical disability: gaps in service provision, problems joining in. J. Paediatric Child Health. 2008 Jul-Aug;44(7-8):455-8 2. HYPERLINK " http://www.ero.govt.nz/ero/publishing.nsf/Content/rtlb-cluster-sep09"  http://www.ero.govt.nz/ero/publishing.nsf/Content/rtlb-cluster-sep09 3HYPERLINK "../../../../../pclark/Local Settings/Temporary Internet Files/OLK23/. http:/www.ero.govt.nz/ero/publishing.nsf/Content/A4351E89CC047966CC25704A007FBD6A%3fOpen". http://www.ero.govt.nz/ero/publishing.nsf/Content/A4351E89CC047966CC25704A007FBD6A?Open#4.3%20RTLB%20practice     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Submission by the Development and Community Paediatric Special Interest Groups of the Paediatric Society of New Zealand Health of our children: Wealth of our nation qr K Z Q Y 5 A !޶zoaYzQhCJ^JhwCJ^Jh0Oh56CJ]^Jh0OhwCJ^Jh0Oh55CJ\^Jh3wh5>*CJ^J h0OhUCJOJQJ^JaJ h0Oh3wCJOJQJ^JaJ h0Oh5CJOJQJ^JaJh0Oh5>*CJ^Jh0Oh0OCJ^Jh0Oh5CJ^Jh0Oh55CJ^Jh0Oh$GCJ^Jqr  \ ] j Uq$ & F$da$gdUgdUgd5$a$gd0O=>?!%%%o)p)q))=*>*?*K*++++//0/1113gd"gd5!,-/<=>W#X#%%v%~%%%%%n)o)p)q))<*=*>*?*K*++.///0/11116677̾߶߫̾߾ט̾ߘ׍zzoht5CJ\^Jh6{h"CJh6{h"5CJh6{h"CJ^JhtCJ^Jh6{h}=rCJ^JhhCJ^JhCJ^Jh0Oh55CJ\^Jh0OhtCJ^Jh5CJ^Jh0Oh5CJ^Jh6{h5CJ^Jh6{hCJ^J(3667777n9y9::;;;;;;;;;;;d 0gdgC dgd5$a$gdtddd-DM [$\$gd5gd5gd"77n9y9z9|999999::: :!:":u:v::::::n;ijĠijĒĒāteXJ@hMCJ^JaJjh{CJU^JaJh{h5CJ^JaJh{ht0JCJ^JaJh{htCJ^JaJ!jh{htCJU^JaJh{CJ^JaJnH tH $h{h5CJKH$^JaJnH tH  h{htCJ^JaJnH tH  h{h5CJ^JaJnH tH "h0Oh55CJ\^JnH tH h0Oh5CJ^Jh0Oht5CJ\^Jn;o;p;;;;;;;;;;;;;;;;<<<4<5<<<<ྲo_QAQAh$G5B*CJOJQJphh$GB*CJOJQJphh$G5B*CJ(OJQJphh$G5B*CJ$OJQJphh$G5OJQJ%jh$G5OJQJUmHnHuhGjhGUh0OhtCJ^JhgCCJ^JnH tH $h{h5CJKH$^JaJnH tH hph{0JCJ^JaJjh{CJU^JaJ!jhMCJU^JaJ;;<<*<+<,<-<.<5<E<T<d<x<<<  $If  $If  !Sn#$If !Sn#$If$ x$Ifa$  $If<<<<<<!="=#=$=%=&='=V=w $ !a$gdt $ !n#a$ !ekd$$If\u+#a <<<<!="=#=X=Y=h0OhtCJ^JhGhjhwhw5CJaJjh$GUmHnHuh$GV=W=X=Y= 0gdgCgdt,&P . 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" # Oh+'0p   , 8 DPX`h TAX INVOICEracp Normal.dotmT4Microsoft Office Word@Ik@`uC@@h),՜.+,D՜.+,< hp  racp^3  TAX INVOICE Title P _PID_HLINKS_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnceAh m<../../../../../pclark/Local Settings/Temporary Internet Files/OLK23/. http:/www.ero.govt.nz/ero/publishing.nsf/Content/A4351E89CC047966CC25704A007FBD6A%3fOpen4.3%20RTLB%20practiceJEhttp://www.ero.govt.nz/ero/publishing.nsf/Content/rtlb-cluster-sep09EOOGPaperPClark@adhb.govt.nz$Phillipa Clark (ADHB)(Paediatrics)  !"#$%&'()*,-./012456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXZ[\]^_`bcdefghkRoot Entry F W{mData +1Table3KWordDocumentTSummaryInformation(YDocumentSummaryInformation8aCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q Paediatric Society of New Zealand: Submissions
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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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