Current status of difficulties and needs of disabled children through research in Quang Ngai province

105 HNUE JOURNAL OF SCIENCE Social Sciences, 2020, Volume 64, Issue 4D, pp. 105-114 This paper is available online at CURRENT STATUS OF DIFFICULTIES AND NEEDS OF DISABLED CHILDREN THROUGH RESEARCH IN QUANG NGAI PROVINCE Nguyen Minh Phuong and Hoang Thi Nho Faculty of Special Education, Hanoi National University of Education Abstract. This article show some screening results of children with disabilities in Quang Ngai province done byHanoi National University of Education with the technical and financial assistance of Christoffel-Blindenmission Christian Blind Mission (CBM) in Vietnam under the project: “Strengthening the capacity of inclusive education network for children with disabilities in Quang Ngai province, Vietnam”. From statistical data and survey indicated that the resource for early intervention and inclusive education in Quang Ngai need to be improved to meet the need of children with disabilities. The paper also given the recommendation for families of children with disabilities and other relevant agencies in Quang Ngai Province to solve difficulties and meet the needs of children with disabilities in the locality. Keywords: chillden withs disability, congenital causes, early intervention, inclusive education, family circumstances. 1. Introduction In Vietnam, the prevalence of disability found in the 2009 Census is 7.8%, of which 4.7% are children and adolescents from aged 5 to 18 years (Census 2009) [1]. However, there are unreliable and outdated data on the number of children under 5 years old with disabilities and information about the types of disabilities. The most recent robust analysis found the total number of children aged 0-18 years with disabilities to be 662.000 (2.4% of the total child population aged 0-18 years). In the 0-6 age group, 76 % of the disabilities is caused by congenital birth defects and 21 % of the disabilities are caused by diseases [2]. The various causes of disabilities include congenital (35.8%), disease (32.34%), the consequences of war (25.56%), occupational accidents - especially road accidents (3.49%) and other causes (1.57%). Information from 2001 to the 2006 shows 125,000 people with disabilities, on average each year about 25,000 people [3]. The reasons reflect human factors, as well as the fact that early childcare and the levels of health services limited in controlling diseases that lead to high disability rates. The consequences of war are also a major cause, not only with the current generation, but also future generations, especially victims of dioxin during the Vietnam-American War [3]. To fit the legal system and international practices to which Vietnam is committed, and especially to meet the desire of persons with disabilities, the Law on People with Disabilities established in 2010 [4]. This was the first step - a very important one – towards the recognition of the responsibility by the Vietnamese Government to include people with disabilities in its Received April 11, 2020. Revised April 24, 2020. Accepted May 15, 2020. Contact Nguyen Minh Phuong, e-mail address: minhphuong.dhsp@gmail.com Nguyen Minh Phuong and Hoang Thi Nho 106 agenda. With the establishment of this law, the Vietnamese Government recognizes their existence, guarantees their rights, and takes responsibility as the first agency to implement this law. An Education Support Policy for people with disabilities has regulated in the law and under law documents. The Law on People with Disability Vietnam 51/2010/QH12 has one chapter regulating education for people with disabilities [4]. The Decree 49/2010/ND-CP regulates school fee exemption and reduction for students with disabilities [5]. Decision 23/2006/QD- BGD&DT regulates inclusive education for people with disabilities (PWD) [6]. Decree 28/2012/ND-CP regulates detailing and guidelines the implementation of several articles of The National Law on Disability [7] and Circular 03/2018/ TT-BGDDT regulates inclusive education for PWD [8]. In theory, the existing policies have mentioned and impacted on all related objects in many areas, including education support systems for PWD. The significant policies include rights of PWD to education, approaches and education establishments for PWD, preferential policies on school fees, policies for those who work in education for PWD, and guidelines as to the contents, approaches, methodologies and assessment of PWD’s education [9]. The Vietnamese Government invests a high proportion of its national budget towards educational services for children. The Government is committed to improving its education system to deliver inclusive education for children with disabilities. Ministry of Education and Training MOET has showed leadership to operationalize the Government’s commitment to provide education for children with disabilities. MOET set up a Committee on Education for Children with Disabilities and Children under Special Circumstances, chaired by a Vice Minister, with representatives from related departments to provide directions and to monitor the MOET’s work. Inclusive education for children with disabilities in Vietnam can be said to have officially shifted from being understood as a “humanitarian” activity to showing responsibility by the actions of individuals. In addition, the quality of education for children with disabilities is improved, not only focussing on mobilizing numbers to integrate classes but also paying attention to the quality of learning for children with disabilities [10], [11]. In order to achieve this goal, the screening and assessment of the difficulties and needs of children with disabilities is an indispensable requirement, not only to help teachers plan care, but also to help educators and other stakeholders to make decisions that help schools, families, community members, and social organizations implement and coordinate care and education for children with disabilities effectively. Based on the findings of the screening program for children with disabilities in Quang Ngai province in May 2017 conducted by the Faculty of Special Education, Hanoi National University of Education, with the technical and financial assistance of CBM in Vietnam under the project: “Strengthening the capacity of the inclusive education network for children with disabilities in Quang Ngai province, Vietnam” [12], this study has been undertaken to analyzie difficulties and needs of Children with Disabilities in the following: children with hearing impairement, children with visual impairement, and children with motor disability. 2. Content 2.1. General Introduction to Research The study aimed at assessing the developmental areas, needs for the care and education of children with disabilities under the age of 16 in three locations in Quang Ngai Province, including: (1) developing the natural resources of Quang Ngai province; (2) assessing the developmental areas and needs in 5 wards / communes (including 5 pilot schools and 5 primary Current status of difficulties and needs of disabled children through researeach in Quang Ngai province 107 schools) in Quang Ngai; (3) assessing the developmental areas and needs in 5 communes (including 5 preschools and 5 primary schools) in Binh Son district. The content focuses on two main issues: (1) Evaluating the developmental areas of the child, including: physical, motor, sensory, language, communication/social interaction, awareness, behavior, character; and emotional health; (2) Assessing the needs of children, including: the need for medical care, early intervention/rehabilitation and education. The evaluation tool is based on existing tools used around the world and updated and adapted for the actual situation of children with disabilities, their families, communities and schools in Vietnam. The toolkit for evaluating children with hearing impairment, visual impairment and mobility impairment includes 5 elements (1 general evaluation form, 1 in-depth evaluation form for hearing impaired children, 2 assessment cards for visual impairment and 1 evaluation form for children with mobility disabilities). Specific assessment methods include: (1) Direct evaluation of the child: Using appropriate assessment tools for each type of disability (pre-primary and primary); (2) Parents of children with disabilities interview: Asking the parent or caregiver of children with disabilities at the time of the child's visit for relevant information to further clarify the information from the direct evaluation of the child; (3) Studying / examining children with disabilities records (medical, study, ...). The number of children assessed with hearing impairment, visual impairment and motor impairment was: 69 hearing impaired children, 10 visually impaired children and 28 children with mobility impairment. 2.2. Findings 2.2.1. General Information on Groups of Children with Disabilities Table 1. General information of children with disabilities Group of disabled children Statistical content Children with hearing impairment Children with visual impairment Children with mobility disabilities Total Number % Number % Number % Number % 1. Gender (Total) 69 100 10 100 28 100 107 100 Male 34 49.3 7 70 14 50 55 51.4 Female 35 50.7 3 30 14 50 52 48.6 2. School level (Total) 69 100 10 100 28 100 107 100 Not yet attending school 1 1.4 1 10 3 10.7 5 4.5 Preschool 6 8.7 2 20 3 21.4 11 10.3 Primary school 62 89.9 7 70 22 78.6 91 85.1 Youth 0 0 1 10 0 0 1 0.93 3. Term of education (Total) 68 100 9 100 25 100 102 100 Special education 55 80.9 1 10 3 12 59 57.8 Nguyen Minh Phuong and Hoang Thi Nho 108 Inclusive education 13 19.1 8 80 22 88 43 42.2 4. Early Intervention (Total) 69 100 10 100 28 100 107 100 Yes 3 4.3 2 20 5 17.9 10 9.3 No 66 95.7 8 80 23 82.1 97 90.7 5. Family circumstances (Total) 69 100 10 100 28 100 107 100 Poor 8 11.6 1 10 2 17.1 11 10.2 Near poor 11 15.9 1 10 12 42.9 24 24.8 Average 44 63.8 8 80 14 50 66 61.7 Wealthier 6 8.7 0 0 0 0 6 5.6 6. Confirmation of disability (Total) 69 100 10 100 28 100 107 100 Have been granted disability certificates 51 73.9 1 10 6 21.4 58 54.2 Have not been issued a certificate of disability 18 26.1 9 90 22 78.5 49 45.8 The Table 1 reflects that children with disabilities who are mobility disabilities, hearing impaired, visually impaired and mobility disabilities at the point of screening show the following statistical content: Gender: The proportion of boys and girls surveyed was similar with 51.4% males and 48.6% females in total ( 49.3% males and 50.7% females of children with hearing impairement; the number of boys who are visually impaired is twice that of girls who are visually impaired; the proportion of boys and girls surveyed who are mobility disabilities was similar, with 50 % males and 50% females). At school level: Primary children were in the the majority with 85,1% in comparision with children who are not yet attending school (4.5%), who are preschool children (10.3%), who are youth (0.93%). Remaining with 89.9% children with hearing impaired, 70% children visually impaired (7 children, accounting for), 78.6% who are mobility disabilities were children of primary school age. This number indicated that’s in Quang Ngai province, the education communicate and implemented mostly done with Primary school level based on compulsary education law at primary level. In terms of education: Special education (57.8%) and inclusive education (42.1%). There is a deference in children with hearing impaired with very high rate of children attend in special education (80.9%), inclusive education (19.1%). This number indicated that human recousre of inclusive school should be improve to meet the need of children with hearing impaired because most of them use sign languge to communicate in school. Early Intervention: The rate of early intervention was very low (9.3% in total). This will greatly Current status of difficulties and needs of disabled children through researeach in Quang Ngai province 109 affect the development of the children, directly affecting the opportunity to integrate children. About family circumstances: Mostly were average (61.7%), followed by near poor (24.8%), less well off and poor. Some children came from poor and disadvantaged families where the children had no parental care but were looked after by grandparents. Confirmation of disability: A large number of children have been granted disability certificates (54.2%). Most of the children who have not been issued a certificate of disability are under-age (according to the commune regulations – they need to be over 6 years old). 2.2.2. Difficulties and Needs of Groups of Children with Disabilities 2.2.2.1. Difficulties and Needs of Children with Hearing Impairment Of the 69 children evaluated, 68 children were found to be deaf from birth, 1 child with cleft lip was not deaf. Children with hearing impairment were evaluated for congenital deafness and late detection of deafness. For most of the children there was no early intervention (only 3 children were in early intervention programs). The children with hearing impairment have significant speech- language difficulties which affects their social and cognitive abilities. At the time of the test, 100% of the children with hearing impairment were equipped with hearing aids. Most of them had been wearing hearing aids since May 1, 2017, funded by the Starkey Hearing Foundation. A hearing aid test showed that: 51.5% of hearing aids worked well; 48.5% of hearing aids had little or no effect. Although there are hearing aids, only 27.9% of the hearing impaired children were able to hear at a hearing level; 8.8% of children with hearing impairment were at the stage of speech recognition; 52.9% of the hearing impaired children could detect sounds while wearing hearing aids and 10.3% of hearing impaired children did not hear any sound at all (chart 1). Most children with hearing impairment can hear mid- range and lower frequency sounds better than high frequency ones. The percentage of children under 3 who could hear the Ling six sound test was quite large (25.1%), 13.2% of the children heard 4 sounds, 7.4% of the children heard 5 sounds and 44.1% of the children heard all 6 sounds in the Ling test. Chart 1. The level of hearing skills of children with hearing impairment Among children with hearing impairment, only about 20% of the children have the ability to understand and express themselves in a less restrictive way, including one who spoke well as a child. These are children who have had early intervention and/or have been well-equipped with hearing aids. These children have great potential to develop spoken language, to be able to study in an inclusive education environment. Of the others, over 80% of children with hearing impairment had significant difficulties in understanding and expressing words. Specifically, children with hearing impairment are limited in verbal and written communication (with Nguyen Minh Phuong and Hoang Thi Nho 110 average scores of1.52 and 1.7). Over 60% of the children did not have verbal capacity. Approximately 80% of the children with hearing impairment did not pronounce words well, lost or omitted the first syllable or just made sounds. 17.6% of the children had hoarse voices. 38.2% of the children with hearing impairment used voice. 8.8% of the hearing impaired children had nasal sounds). Reading and writing ability was quite limited (children often found it difficult to choose words, wrote words in the wrong grammatical order and their ability to read text was not good) (Table 2). Table 2. Levels of understanding and expression of children with hearing impairment Ability Understanding (%) Expression (%) Average overall Means of communi -cation Not yet Limit Limited Good Medium score Not yet Limit Limited Good Medium score Speech 63.2 14,7 20,6 1,5 1,6 73,5 8,8 16,2 1,5 1,45 1,52 Sign 17,6 14,7 10,3 57,4 3,07 17,6 14,7 10,3 57,4 3,07 3,07 Writing 51,5 25 23,5 0,0 1,72 51,5 27,9 20,6 0,0 1,69 1,7 Visual images and actions 0,0 0,0 0,0 100,0 4,0 0,0 0,0 0,0 100,0 4,0 4 Among 55 children currently enrolling in the Center for Inclusive Education Development in Quang Ngai Province, most of them have not been provided with early intervention, have limited speech and ability to communicate. Children are able to communicate fairly well in sign language. The learning ferformancemost have been achieved according to the specific program that children are studying. There is quite a high rate of children have significant difficulties in reading comprehension and sentence writing. However, in this group there are some children who are able to hear at a basic level and are well aware. These children could be transitioned to an inclusive environment with the support of the Inclusive Education Development Assistance Center. Among 13 children with hearing impairment screened in the community, 5 children had early intervention and/or were fitted with appropriate hearing aids, had good hearing ability and were intergrated in regular school. The remaining children, with hearing aids that are not effective, are not able to hear and express speech. These children do not know sign language, cannot read and write, so these children do not have the language with which to communicate and to learn, which seriously affects their development of cognitive behavior. These children should be screened and fitted with appropriate hearing aids. They will need assistance from the Inclusive Development Support Center to learn sign language to access communication and the synthesis of language. 2.2.2.2. Difficulties and Needs of Children with Visual Impairement Among 10 children with visual impairment surveyed, the number of children who had vision at the lowest level was the highest (60%). Most of the children’s impairements are due to birth defects. The number of children with cataracts is high (40%). Of the four children with cataracts, only two were examined at major hospitals (Da Nang Hospital and HCM City Eye Hospital), and one was involved in cataract surgery at the age of 3. After the first surgery the results were that his visual impairment was classified as severe. Assessment now shows that his eyesight has progressively improved and he can wear glasses to read and write well. Almost children with visual impairment have certain difficulties in mobility and independence skills due to visual limitations. Only a small percentage (2 children—20%) had visited to large hospitals for intervention and, periodic treatment. All 10 children had different degrees of visual impairment with varying degrees of effect on their ability to learn, exercise Current status of difficulties and needs of disabled children through researeach in Quang Ngai province 111 and to be independant. In particular, one child was older but was not supported to learn to read and write at a young age and this seriously affects that child’s ability to read and write today. Two children with visual impairment had severe effects on learning ability and they had signs of other disabilities.. Visual difficulties also have a profound effect on the children's ability to read and write, and all the students surveyed had slower reading and writing skills. The survey also showed that Quang Ngai Center for Inclusive Education and Development has not yet implemented su