A comprehensive service delivery model for preschoolers with special educational needs: Its characteristics and effectiveness

BackgroundThe compartmentalization between early intervention services and early childhood special education programs is a worldwide phenomenon, which results in the fragmentation of services for preschoolers with special educational needs (SEN).AimsTo address this fragmentation of services, an intervention program in Hong Kong adopted a comprehensive service delivery model with six characteristics: 1) multidisciplinary approach, 2) integration of services across different contexts, 3) multimodal intervention with direct and indirect services, 4) capacity building for systems, 5) inclusive environment, and 6) high program intensity.MethodsThe program evaluation was a quasi-experiment with a control group (n = 60) matched to the experimental group (n = 60).ResultsAt the end of the school year, the experimental group made significant improvement in most measures including cognitive skills, receptive language skills, expressive language skills, gross-motor skills, fine-motor skills, and self-direction skills. School heads in the experimental group also agreed that the program had empowered their teachers and reinforced their school systems.ConclusionDespite its exploratory nature, the study has shed light on the future directions of services for preschoolers with SEN. The comprehensive service delivery model offers a response to the fragmentation of services and reveals the importance of integration of services across different contexts with multidisciplinary approach.     

Cumulative risk effects for the development of behaviour difficulties in children and adolescents with special educational needs and disabilities

Research has identified multiple risk factors for the development of behaviour difficulties. What have been less explored are the cumulative effects of exposure to multiple risks on behavioural outcomes, with no study specifically investigating these effects within a population of young people with special educational needs and disabilities (SEND). Furthermore, it is unclear whether a threshold or linear risk model better fits the data for this population. The sample included 2660 children and 1628 adolescents with SEND. Risk factors associated with increases in behaviour difficulties over an 18-month period were summed to create a cumulative risk score, with this explanatory variable being added into a multi-level model. A quadratic term was then added to test the threshold model. There was evidence of a cumulative risk effect, suggesting that exposure to higher numbers of risk factors, regardless of their exact nature, resulted in increased behaviour difficulties. The relationship between risk and behaviour difficulties was non-linear, with exposure to increasing risk having a disproportionate and detrimental impact on behaviour difficulties in child and adolescent models. Interventions aimed at reducing behaviour difficulties need to consider the impact of multiple risk variables. Tailoring interventions towards those exposed to large numbers of risks would be advantageous.     

A controlled trial of the SibworkS group program for siblings of children with special needs

Siblings of children with a disability are an at risk group for emotional and behavioral problems. This study evaluated an intervention to promote the emotional and behavioral functioning of siblings of children with disabilities and chronic health conditions. SibworkS is a six-week manual-based, cognitive–behavioral group support program focussed on strengthening siblings’ perceived social support, self-esteem, problem-solving skills, adaptive coping behaviors and positive sibling relationships. Fifty-six children aged 7–12 were allocated to either the SibworkS program (n = 30) or waitlist control (n = 26) in alternating sequence. The primary outcome was siblings’ emotional and behavioral functioning. Additional outcomes were self-esteem, perceived social support, the sibling relationship and coping behaviors. Siblings were followed-up immediately after the intervention and at 3-months. Siblings participating in the SibworkS intervention were reported to have fewer emotional and behavioral difficulties than siblings in the control group immediately following the intervention and at the 3-month follow-up. Participation in SibworkS was associated with fewer emotional and behavioral difficulties for siblings. Implications for practice and future research include recommendations for improving program participation.     

The emotional and behavioural functioning of siblings of children with special health care needs across childhood

This study examined the emotional and behavioural functioning of siblings of children with special health care needs identified in the Longitudinal Study of Australian Children (LSAC). Of the 106 siblings identified, 15–52% had emotional and behavioural difficulties in the at-risk or clinical range on the parent-reported Strengths and Difficulties Questionnaire (SDQ) subscales when aged 4–5 (wave 1), 6–7 (wave 2), 8–9 (wave 3) and 10–11 years (wave 4). After controlling for differences in socio-economic position, siblings had significantly higher difficulties on all subscales than their peers without a brother or sister with a special health care need at most time points. Latent growth modelling revealed little change in emotional and behavioural symptoms for siblings across childhood, while behavioural symptoms decreased for their peers. These findings suggest that some siblings are at heightened risk of emotional and behavioural difficulties across childhood, underscoring the importance of assessing and promoting the wellbeing of all family members when providing services to children with special health care needs.     

Development and validation of the Paediatric Care and Needs Scale (PCANS) for assessing support needs of children and youth with acquired brain injury

Aim: The Paediatric Care and Needs Scale (PCANS) is a newly developed scale that assesses support needs following childhood acquired brain injury (ABI). It yields three measures of support: overall, extent and intensity. The developmental process of the PCANS is described and concurrent and construct validity examined.

Method: In the validation study, 32 parents/caregivers of children with ABI aged 5–18 years completed the PCANS and other validating measures: Vineland Adaptive Behavior Scales (VABS), Functional Independence Measure for Children (Wee-FIM) and King's Outcome Scale of Childhood Head Injury (KOSCHI). VABS and Wee-FIM sub-scales examining similar and dissimilar domains to the PCANS were used to investigate convergent and divergent validity, respectively. Discriminant validity analysis used sub-groups dichotomized by VABS and KOSCHI data.

Results: Statistically significant correlation coefficients of moderate-to-strong magnitude were found between the PCANS support intensity score and most of the VABS, Wee-FIM and KOSCHI variables (r_s = ?0.46 to r_s = ?0.77, p < 0.01). Some evidence for convergent and divergent validity was also found. Correlation coefficients between similar domains of the PCANS and other scales were moderately high (e.g. VABS socialization vs PCANS psychosocial items, r_s = ?0.64, p < 0.01). Conversely, correlation coefficients between dissimilar domains were low (e.g. Wee-FIM self-care vs PCANS psychosocial items, r_s = ?0.29). In terms of discriminant group differences, PCANS support extent and intensity scores were able to distinguish between sub-groups dichotomized by VABS and KOSCHI scores.

Conclusions: These findings provide preliminary evidence for the validity of the PCANS for assessing support needs after paediatric ABI.     

Development of the language subtest in a developmental assessment scale to identify Chinese preschool children with special needs

This study reports on the development of the language subtest in the Preschool Developmental Assessment Scale (PDAS) for Cantonese-Chinese speaking children. A pilot pool of 158 items covering the two language modalities and the three language domains was developed. This initial item set was subsequently revised based on Rasch analyses of data from 324 multi-stage randomly selected children between 3 and 6 years of age. The revised 106-item set demonstrated adequate measurement properties, including targeting and uni-dimensionality. The revised 106-item set successfully discriminated preschool children in the three age groups, and between preschool children and their age peers with special education needs (SEN). Results from this study support the collection of normative data from a larger population sample of children to examine its accuracy in identifying language impairment in children with SEN. Test development procedures reported in this study provide insight for the development of language subtests in multi-domain developmental assessment tools for children speaking other varieties of Chinese.     

Assessing educational outcomes in middle childhood: validation of the Teacher Academic Attainment Scale

Aim Assessing educational outcomes in high‐risk populations is crucial for defining long‐term outcomes. As standardized tests are costly and time‐consuming, we assessed the use of the Teacher Academic Attainment Scale (TAAS) as an outcome measure. Method Three hundred and forty three children in mainstream schools aged 10 to 11 years (144 males, 199 females; 190 extremely preterm and 153 term; mean age 10y 9mo, SD 5.5mo, range 9y 8mo–12y 3mo) were assessed using the reading and mathematics scales of the criterion standard Wechsler Individual Achievement Test, 2nd (UK) edition (WIAT‐II). Class teachers completed the TAAS, a seven‐item questionnaire for assessing academic attainment. The TAAS was also completed at 6 years of age for 266 children. Results Cronbach’s alpha 0.95 indicated excellent internal consistency, and the correlation between TAAS scores at 6 and 11 years indicated good test–retest reliability (r=0.77, p<0.001). Significantly higher TAAS scores for term vs preterm children demonstrated discriminative validity. TAAS scores at 6 and 11 years were significantly correlated with WIAT‐II reading (r=0.69 and 0.75, p<0.001) and mathematics (r=0.75 and 0.82, p<0.001) scores, demonstrating good predictive and concurrent validity respectively. TAAS scores of <2.5 were good predictors of learning difficulties. Interpretation The TAAS is a brief, psychometrically sound teacher‐report of academic attainment that yields continuous and categorical outcomes. It provides a cost‐ and time‐efficient outcome measure for large‐scale studies.     

Inclusion of children with developmental disabilities in Arab countries: A review of the research literature from 1990 to 2014

BackgroundIn this study, a literature review was conducted to analyze studies published from 1990 to 2014 in English-written literature on inclusion of children with developmental disabilities in Arab countries.AimsThis study sought to review and analyze research conducted on Inclusive Education (IE) in Arab countries.Methods and proceduresThe following electronic databases were used in searching the relevant literature: ScienceDirect, SpringerLink, PsychINFO, EBSCOhost Databases, ProQuest Dissertations and Theses Database, ERIC, and Google Scholar. After the publications to be included in this study were retrieved, each study was reviewed and analyzed. Each study was examined for details such as authors, title of research, publication year, country, purpose, methods, and key findings.Outcomes and resultsThe results showed that a total of 42 empirical studies related to inclusion of children with developmental disabilities in Arab countries have been published. More than two-thirds of these studies came from United Arab Emirates (UAE), Jordan, and Saudi Arabia. The majority of the studies were published in the last 6 years. The main parameters in these studies were: attitudes toward inclusion, barriers to inclusion, and evaluating inclusion.Conclusions and implicationsThe results of the current study revealed that relatively little IE research has been conducted in Arab countries. More research is warranted to test the generalizability of the results of the current study. Further research is also needed to analyze IE practices and demonstrate strategies for the effective implementation of IE in these countries.     

Associations and costs of parental symptoms of psychiatric distress in a multi-diagnosis group of children with special needs

Background Families supporting children with complex needs are significantly more distressed and economically disadvantaged than families of children without disability and delay. What is not known is the associations and costs of parental psychiatric distress within a multi‐diagnosis group of special needs children. Methods In this cross‐sectional survey, families were identified from the Children's Treatment Network. Families were eligible if the child was aged 0–19 years, resided in Simcoe/York, and if there were multiple family needs (n = 429). Results Some 42% of surveyed parents exhibited symptoms (mild to severe) of psychiatric distress. The presence of these symptoms was associated with reports of poorer social support, family dysfunction, greater adverse impact of the child's situation on the family, poorer child behaviour, unfavourable parenting styles and poorer child psychosocial functioning. The severity of the child's physical dysfunction was not related to parents/guardians most knowledgeable symptoms of psychiatric distress. Total parent costs were higher and children's uses of primary care services were higher in parents with symptoms of psychiatric distress. Conclusion Parent symptoms of psychiatric distress are a significant societal concern in families with complex needs children. Children's rehabilitation efforts need to incorporate parental mental health assessment and treatment into existing programmes. This could lead to decreases in direct and indirect healthcare utilisation costs.     

Program of arithmetic improvement by means of cognitive enhancement: An intervention in children with special educational needs

This study reports the cognitive and arithmetic improvement of a mathematical model based on the program PASS Remedial Program (PREP), which aims to improve specific cognitive processes underlying academic skills such as arithmetic. For this purpose, a group of 20 students from the last four grades of Primary Education was divided into two groups. One group (n = 10) received training in the program and the other served as control. Students were assessed at pre and post intervention in the PASS cognitive processes (planning, attention, simultaneous and successive processing), general level of intelligence, and arithmetic performance in calculus and solving problems. Performance of children from the experimental group was significantly higher than that of the control group in cognitive process and arithmetic. This joint enhancement of cognitive and arithmetic processes was a result of the operationalization of training that promotes the encoding task, attention and planning, and learning by induction, mediation and verbalization. The implications of this are discussed.     

The effects of valproate exposure in utero on behavior and the need for educational support in school-aged children

Children exposed to valproate monotherapy in utero were evaluated with respect to neurological functioning, behavior, and additional educational needs, and the results were compared with those for age- and gender-matched controls exposed to carbamazepine and children with no prenatal exposure to antiepileptic drugs. We identified from the community-based pregnancy registry of Kuopio University Hospital area (1989-2000) all first-born and school-aged children exposed to valproate (N=13). Neurological and neuropsychological assessments were made clinically, and behavioral problems were assessed with the Conners' Teacher Rating Scale (CTRS). Eight children (62%) exposed to valproate and two (15%) each in the carbamazepine-exposed and nonexposed groups (P=0.022) required educational support. Minor dysmorphic features were noted in eight children (62%) exposed to valproate and in three children (23%) each in the carbamazepine-exposed and nonexposed groups. On CTRS, children exposed to valproate received higher scores, indicating behavioral problems. In our small but population-based study, all children exposed to valproate had minor, and some of them major, cognitive or neurological problems. This difference is clearly observed when assessing each child individually, but the many confounding factors explaining at least part of this difference are difficult to control and avoid in clinical practice. Larger studies with a prospective design are needed to confirm these findings.     

Mental health services in schools: the challenge of locating a psychotherapy service for troubled adolescent pupils in mainstream and special schools

In Part 1, the case is presented for school-based mental health services in terms of the low utilization of community-based clinics and the high dropout rate among young adolescents attending clinics in the community. The advantages and potential pitfalls of school-based services are also assessed. In Part 2, the paper discusses the lessons learned from delivering psychotherapy services in mainstream and special schools to tackle the mental health problems presented by troubled pupils. The author describes the schools and discusses the expectations among teachers of the psychotherapist and psychologist. The role of the psychotherapist and psychologist in the schools is outlined. The types of treatment approach, the setting for treatment, method of referral, parental consent, and links with the wider network of adolescent mental health services and evaluation of outcome are considered. Finally, the author discusses the tensions that can arise between the psychotherapist and psychologist and school staff and ways of overcoming them.     

Identifying the educational needs of physicians in pediatric epilepsy in order to improve care: results from a needs assessment in Germany,Spain, and the United States

Aims. The objective of this study was to gather evidence‐based data on the educational needs of neuropediatricians. A needs assessment was conducted to identify the clinical challenges of physicians when diagnosing, medically treating, and managing pediatric patients with epilepsy; which could be addressed through educational interventions. Methods. A two‐phase mixed‐methods approach was used to conduct the needs assessment in Germany, Spain, and the US. Phase 1 consisted of qualitative data collection through multiple sources: a literature review, semi‐structured interviews with clinicians and nurses working in pediatric epilepsy, and interpretation and input from faculty experts. Qualitative data were coded (NVivo) and analyzed using a thematic analysis, and findings were then used to design the second phase. Phase 2 consisted of quantitative data collection through an online survey that aimed to validate the identified challenges and underlying causes using a larger sample than in Phase 1. Data from the survey were analyzed using frequency tabulations and chi‐square tests (SPSS). Results. A total of 267 participants were included in the study. Phase 1 included 88 participants (neurologists, pediatricians, neuropediatricians, and nurses). Phase 2 included 179 participants (neurologists, pediatricians, and neuropediatricians). The main areas of challenge which emerged from the triangulated data included: the integration of guidelines into practice, identification of epilepsy and epilepsy events, integration of genetic testing into practice, integration of non‐pharmacological treatments, transition from pediatric to adult care, and involvement and engagement with caregivers. Underlying causes of these challenges are reported, along with supporting qualitative findings. Conclusions. This study identified the educational needs of physicians working in pediatric epilepsy in Germany, Spain and the USA. Increasingly, educational interventions are required to be evidence‐based. The results of this study could be used to design such interventions to support neuropediatricians who wish to specialize in pediatric epileptology, in order to manage the identified challenges.     

Development and validation of a questionnaire to measure the service needs of families with children with developmental disabilities

The aim of this project was to develop and validate a Service Needs Questionnaire (SNQ) on the service needs of families with children with developmental disabilities. The SNQ and a measure of parenting stress were administered to 105 parents of children diagnosed with learning/behaviour problems and 233 parents of children attending primary schools. Initial Rasch analysis results indicated inadequate distinction of the categories and the fit statistics of three items were outside the acceptable range. The categories were collapsed and the removal of two misfitting items resulted in a scale which conformed to the Rasch expectations. For validity, the scale correlated positively with parenting stress, and it could differentiate between parents of children diagnosed with learning/behaviour problems and those attending primary schools. The internal consistency estimate (the Cronbach α) was above .70. The SNQ could be used to help identify the needs of families with children with developmental disabilities.     

Assessing the needs of pregnant women and mothers with severe mental illness: the psychometric properties of the Camberwell Assessment of Need - Mothers (CAN-M)

There is an absence of standardized validated instruments to assess the complex needs of pregnant women and mothers with severe mental illness. We aimed to develop a standardized assessment of need for pregnant women and mothers with severe mental illness. Staff and service users were asked to identify relevant domains of need. Professional experts and service users were then surveyed and asked to rate the importance of the domains of the Camberwell Assessment of Need - Mothers version (CAN-M). Reliability was established using 36 service user-staff pairs. Concurrent validity was assessed with the Global Assessment of Functioning. Inter-rater reliability (concordance) coefficients for unmet needs were 0.93 (95% confidence interval 0.89 to 0.98) (service users) and 0.83 (95% confidence interval 0.73 to 0.94) (staff); test-retest reliability coefficients were 0.91 (95% confidence interval 0.86 to 0.97) and 0.85 (95% confidence interval 0.73 to 0.96), respectively. Relevant CAN-M domains correlated with the Global Assessment of Functioning-symptom (Spearman's r correlation coefficient = -0.36, 95% confidence interval = -0.62 to -0.04, p = 0.05) and Global Assessment of Functioning-disability subscales (Spearman's r correlation coefficient = -0.52, confidence interval = -0.73 to -0.23, p < 0.01).We conclude that the CAN-M is a reliable and valid instrument for assessing the needs of pregnant women and mothers with severe mental illness.     

Assessing the needs of people with learning disabilities and mental illness: development of the Learning Disability version of the Cardinal Needs Schedule

BACKGROUND: People with learning disability (LD) experience a range of mental health problems. They are a complex population, whose needs are not well understood. This study focuses on the development of a systematic process of needs assessment for this population. METHODS: The Cardinal Needs Schedule used in general psychiatry was adapted for people with learning disabilities (LD). The Learning Disability version of the Cardinal Needs Schedule (LDCNS) was tested on a sample of 35 people with LD and mental illness for its inter-rater reliability. RESULTS: The inter-rater reliability (Kappa) was calculated for 22 areas of functioning assessed by the LDCNS. Overall, there was very good agreement in seven areas, moderate agreement in six areas, fair agreement in three areas and poor agreement in one area. In four areas of functioning, Kappa could not be calculated. More needs were found in the social domain than in the clinical domain. CONCLUSION: A systematic needs assessment schedule (LDCNS) was developed for people with LD and mental illness. The inter-rater reliability is generally acceptable, but requires further examination.     

The Screening Tool of Feeding Problems applied to children (STEP-CHILD): psychometric characteristics and associations with child and parent variables

The present study evaluated the 23-item Screening Tool for Feeding Problems (STEP; Matson & Kuhn, 2001) with a sample of children referred to a hospital-based feeding clinic to examine the scale's psychometric characteristics and then demonstrate how a children's revision of the STEP, the STEP-CHILD is associated with child and parent variables. Participants included 142 children (95 boys, 47 girls; mean age = 61.4 months; 43 with autism, 51 with other special needs, 48 with no special needs). Children ranged in age from 24 months to 18 years. Factor analysis revealed a 15-item STEP-CHILD with six subscales of child feeding problems: CHEWING PROBLEMS, RAPID EATING, FOOD REFUSAL, FOOD SELECTIVITY, VOMITING, and STEALING FOOD. Mediation analysis documented that “overly permissive” actions by parents (such as infrequent insistence on eating during meals, or frequent preparation of Special Meals for children different than the family meal) explained over 34% of the links between children's feeding problems and poor weight and diet outcomes.