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

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.

This paper is available online at http://stdb.hnue.edu.vn

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of which 4.7% are children and adolescents from aged 5 to 18 years (Census 2009) [1] However, there are unreliable and outdated data on the number of children under 5 years old with disabilities and information about the types of disabilities The most recent robust analysis found the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

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

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

2 School level

Not yet

3 Term of

education

(Total)

Special

108

Inclusive

4 Early

Intervention

(Total)

5 Family

circumstances

(Total)

6 Confirmation

of disability

(Total)

Have been

granted

disability

certificates

Have not been

issued a

certificate of

disability

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

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

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

Average overall

Means of

communi

-cation

Not

yet Limit Limited Good

Medium score

Not yet Limit Limited Good

Medium score

Visual

images

and

actions

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

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 supportive activities for visually impaired children and is without professional support staff Learning in an integrative environment of underprivileged children is also inadvisable and needs a great deal of support for the adjustment of teachers and facilities at home and at school Only two children used personal lights when studying

There was a child with visual impairment who is currently studying in kindergarten She needs to develop tactile skills, directional movement and be prepared with pre-Braille reading and writing skills so that she can prepare for primary school Both school teachers and teachers

at the Center for Inclusive Education have not prepared enough to meet the needs of primary school children There was another 6-year-old-child with visual impairment who need to study and be provided with support in many specialized and individual approaches

Among the remaining cases, most of them are low-vision children who can study in inclusive schools now, but they need support in adjusting the equipment and support facilities to ensure better conditions for the development of the children's literacy However, schools and the families are not aware of the importance of this and they lack knowledge and skills in supporting and adjusting the learning environment for these children

2.2.2.3 Difficulties and Needs of children with Mobility Disabilities

Among 28 children with mobility impairments, the number of children with disabilities in the lower limbs is high Most childrens’ mobility impairment was due to congenital causes (25 children, 89.2%) Among of them, 3 children with mobility disability was due to accidents (accounted for 11.8%) At the time of the survey, most children with mobility disabilities did not have any means of support in their daily activities and travel

Results of the evaluation also indicate that among the children with mobility disabilities who were screened, there was a high proportion of children with cerebral palsy (a total of 17 children, accounting for 60.9%) The mobility, pronunciation, independance skills and literacy

of children with mobility impairments are affected

28 children assessed with mobility impairments had different degrees of motor impairment There were three children who did not clearly show a degree of movement impairment that would have a strong influence on the development of the child (One child had signs of health problems that need to be followed up and two sisters had weak but difficult mobility but the main disadvantage for these girls is their limited ability to learn

In most cases, children with mobility disabilities have very difficult family circumstances and very few children have wheelchair support Of the children who received screening, three children with disabilities were examined at the hospital and participated in a rehabilitation program and an early intervention program For one child, although the assessment was heavy, the effects of motor disability on speech and learning are unknown These children are given appropriate and effective early intervention because parents are well aware of the importance of rehabilitation and early childhood training

Among children with learning dificulty who are currently studying at the Quang Ngai Inclusive Education Development Center, most of them have language difficulties and cognitive abilities are attained according to the specific program they are following They have significant language difficulties because of the impact of violence Among the children who study here, there is one child who, although the level of motor impairment is quite severe, has been well

112

educated., There are many advances that can be considered so that the children can be transferred gradually into an integrated environment with the support of the Inclusive Education Development Center

For children with mobility disabilities in Quang Ngai and Binh Son Districts, there are 3 children in kindergarten, 22 children in primary schools, and 3 children of preschool age learning Understanding the views of parents and the school shows that they often have a point

of view when the children are independent and are able to walk, parents can get them to school, which limits their motivation This has greatly reduced children's chances of early integration Out of 3 children who have not attended school, 2 children were interviewed by pre-school teachers, both of whom were able to communicate well but the severity of motor impairment was very high and they needed wheelchairs to support mobility to be able to integrate However, they have not been able to attend school due to the difficult economic conditions of the family Only grandparents are the main caregivers

3 Conclusions and recommendations

3.1 Some General Conclusions Drawn from the Research Results

The time of detection of disabilities is quite late Most children with disabilities do not receive treatment and intervention in time so that the quality of social skills and learning (both specialized and inclusive) are very limited

The current disability certificate is not suitable: children over 6 years old are eligible for a disability certificate

Teachers lack knowledge and skills in assessing, treating, intervening and supporting CWD (young individuals and in classrooms and schools) There is a lack of skills and tools to communicate with children with disabilities This is show that most of children who are deaf are attending in special school system Similarly, parents have not been guided for adjustments to support their children in living and studying at home

There is a lack of equipment for teaching and learning in the school and in the family Only

a small number of children with disabilities (hearing impaired, motivated) are provided with supportive devices (hearing aids, wheelchairs) and teachers and parents have not been instructed

on how to use them

Schools, social services, and the Quang Ngai Inclusive Education Development Assistance Center are not yet ready to support children with disabilities and their families in assessing developmental needs, intervention, counseling and organizing activities to ensure the participation of children with disabilities in schools and communities

3.2 Recommendations

Based on the above findings, we make some recommendations for families of children with disabilities and their families in Quang Ngai Province as follows:

3.2.1 For Families with Children with Disabilities

Seek information and opportunities to acquire knowledge and skills to care for and provide intervention and support for children with disabilities online, in workshops, club activities and other activities with people with disabilities, community activists and schools that welcome the participation of children with disabilities

Maintain regular contact with Quang Ngai Inclusive Education Center and local schools to receive support and counseling on how to care for, provide intervention, and treat and educate CWD in the community At the same time, families should regularly exchange information

about their children with disabilities with teachers, staff and managers of these specialized units Maintain regular follow-up of family therapy activities, intervention, and support to children with disabilities on the basis of learning observation from the guidance of school teachers and the Inclusive Education Center

Select and decide on the educational environment or mode or to combine therapeutic, intervention and educational modes appropriate to the abilities and needs of children with disabilities

3.2.2 For Quang Ngai Inclusive Education Center

Be active and cooperate with provincial agencies and organizations to organize awareness-raising activities for parents of children with disabilities and members of organizations and stakeholders on disability issues and rights of children and on disability knowledge, skills in care, treatment, intervention and support for children with disabilities

Develop programs and organize evaluation, treatment, intervention, education, support for children with disabilities, and counseling for family members in the Center to meet the integration needs of children with disabilities (1 to 2 times per week, 1-2 hours per child at the Center) Regularly coordinate with the education and training sections and local integration schools

to identify and plan for support for children with disabilities and provide professional support to teachers who are teaching in inclusive education

Develop a plan to support children with disabilities at Centers and kindergartens and primary schools in the 2017-2018 school year, focusing on the schools in the project area Choose, plan, and train to improve the capacity of the staff to meet the above-mentioned tasks and activities (audiology, children's evaluation, early intervention and treatment, use of communication tools, etc.)

There should be a transition plan for children with disabilities who are able to integrate and those who transfer to secondary school or to vocational training institutions in the area

3.2.3 For the Two Education and Training Offices (Quang Ngai City and Binh Son District) and Kindergartens

Take initiative and coordinate with units / organizations of the district / commune (Health, Labor, and Social Affairs, Culture and Information, People with Disabilities) to organize activities to raise awareness, provide information for parents of children with disabilities and members of organizations and stakeholders on disability issues, rights of children with disabilities, knowledge and skills in the care, treatment, intervention and support for children with disabilities

Regularly collaborate with the IE Development Support Center to assess, treat, intervene and support the integration of children with disabilities and improve the knowledge and skills of teachers At the same time, ensure close coordination with the families of children with disabilities in organizing the implementation of these activities

Develop a plan to detect, receive, pay for classes, and support children with disabilities at school in the school year 2017-2018 and strengthen the guiding role of the Department of Education and Training for this work

Select the core staff of the Department and each school and at the same time have implementation plans to train and foster the capacity of this core team to meet the delivery of focussed tasks and activities

Proactively provide information and records to the commune / ward level disability determination council to help streamline the process of granting disability certificates

114

3.2.4 For Quang Ngai Department of Education and Training

Strengthen the direction of the Education and Training Divisions and schools on statistics, dossiers and plans for individual education for children with disabilities

Direct Education and Training Offices, schools providing education, teaching and inclusive support for children with disabilities who have not been issued with a disability certificate (but have been provided with family, teacher and or for children who are not on the list of disabilities under the Law on People with Disabilities (such as children with autism disorder, children with learning disabilities, etc.)

REFERENCES

[1] UNFPA, 2011 People with Disabilities in Vietnam: Key Findings from the 2009 Vietnam

https://vietnam.unfpa.org/sites/default/files/pub-pdf/Disability_ENG.pdf

[2] UNICEF Viet Nam, 2016, Country Program, Strategy for Children with Disabilities Issues, strategies, programmatic priorities, and partnerships to improve the well-being of children with disabilities in Viet Nam, Draft outline of the strategy

[3] Nguyen Thi Hoang Yen, 2012 Special Education: Its history and terminology, Hanoi

national university of Education Publishing house

[4] Vietnam Congress, 2010 The Law on People with Disabilities Vietnam 51/2010/QH12, Hanoi

[5] Vietnam Government, 2010 The Decree 49/2010/ND-CP Regulating School Fee Exemption and Reduction for Students with Disabilities., Hanoi

[6] Vietnam Ministry of Education and Training, 2006 Decision 23/2006/QĐ-BGD&ĐT Regulating Inclusive Education for People with Disabilities, Hanoi

[7] Vietnam Government, 2012 The Decree 28/2012/ND-CP regulates detailing and guidelines the implementation of a number of articles of The National Law on Disability, Hanoi

[8] Vietnam Ministry of Education and Training, 2018 Circular No.03/2018 / TT-BGDDT regulates inclusive education for people with disabilities, Hanoi

[9] Nguyen Minh Phuong, Nguyen Ha My, Tran Thi Bich Ngoc and Pham Thi Hai Yen, 2019

Conditions to ensure the succes of inclusive education for children with disabilities, HNUE Journal of Science, Volume 64, Issue 9AB, pp 115-122

[10] Nguyen Xuan Hai, 2010 Inclusive Education Manager, Publisher of Hanoi University of

Education

[11] Hoang Thi Nho, 2014 Mathematic Performance and the correlation with the factors

related in learning of grade 1 students with visual impairment in inclusive setting, HNUE Journal of Science, Volume 59, Number 6 BC, pp 351-359

[12] CBM in Vietnam and Hanoi National University of Education, 2017 Synthesis Report on screening results for children with disabilities in Quang Ngai, Hanoi