1. JO MCCLELLAN IKAMVA LABANTU 1 ECD Conference

2. 2 Ikamva Labantu and the ECD Team 2 Ikamva Labantu is a Non-Profit Organisation operating within the townships of South Africa. It’s programmes include helping orphans and vulnerable children - over 1000 through 300 care homes and senior citizens in 17 senior clubs. It also runs an ECD department staffed by professionals and community-based workers. The ECD Department works in association with the Educare Forum Itemba Labantwana to help over 12,000 pre-school children in over 200 day care centres.

3. 3 Four Areas of Concern 3 1. Identification within the preschool 2. Referrals made by preschools 3. Children dropping out of the health system during diagnosis procedures 4. Recommended interventions not being carried-out back in the community

4. Outline Special educational needs must be included in basic holistic services Early identification is essential to…  Society  The educational system  Prognosis of children Ikamva Labantu early identification pilot project Prognosis Education system Society

5. 5 This Presentation 5 This talk does not focus on statistics and research concerning the importance of early identification and intervention It will focus on the four points identified above in relation to the following areas: 1. What we saw in the Preschools 2. How the Ikamva Labantu project attempted to address these challenges 3. How we monitored our pilot project to ensure our perception reflected ‘real situation’.

6. 6 First area of concern: Early identification in the preschools 6 Children had not been identified Children had been identified but staff/ parents did not know whether to refer Preschool staff had identified a difficulty but carers had not agreed with referral and in some situations threatened to remove children if further action was taken

7. 7 Addressing these issues 7 Implementation of training for preschool staff, parents and community based workers to increase knowledge and encourage confidence To provide a peripatetic professional to discuss any concerns about referrals: To ensure accurate referral To install confidence in staff To discuss matters and, where necessary, mediate with parents

8. 8 Second: Referrals made from preschools 8 Main concerns reported by preschool staff:  Whether to make a referral  To whom to refer  How to make referral  Where to make referral  Consequence: Mainly general referral to Local Hospital.

9. 9 Addressing these issues 9 As part of training programme we include a workshop on Special Needs and the key to good referral. ECD team felt it important to help staff in the understanding of how to recognize; 1. The challenges of the child 2. Whether the child has an overall delay or a specific problem 3. Which professionals ideally should become involved in with each case

10. 10 Physical Movement Speech Emotional Literacy Reading Writing Attention Sensory Hearing/Vision Understanding

11. 11 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 Physical Literacy SpeechEmotional Attention Global Developmental Delay – Professional Involved Educational Psychologist Understanding

12. 12 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 Physical Understanding Emotional AttentionLiteracy Speech Physical Disability –Professional involved Physiotherapist

13. 13 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 PhysicalAttention Emotional Understanding Literacy Speech Reading Writing or Literacy Disabilities – Professional involved Remedial Teacher

14. 14 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 Physical UnderstandingEmotional AttentionSpeech No speech disorder but overall delay

15. 15 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 PhysicalAttention Emotion al Understanding Literacy Speech Speech and Language Disabilities – professional involved Speech Therapist

16. 16 Training of community workers and educators = 97% ACCURATE REFERRAL 16

17. 17 Benefits of accurate referral 17 Prevents clogging within the health and education system Encourages child to stay in system

18. 18 Third: supporting child in the system 18 Reports on why children were falling out of the system  Getting to appointment; transport etc  Primary care-givers unable to take time off work  Care-givers did not understand the doctor’s initial diagnosis or explanations and therefore did not attend further appointments  Poor referrals resulting in families being directed from one department to another; loss of motivation

19. 19 Addressing these issues 19 Peripatetic professional able to make direct referral which reduced extra appointments and a long process to get to specialists i.e. Red Cross Hospital Community- based workers reminded care-givers two days before appointments Provided follow-up appointments with community-based workers, or if necessary peripatetic worker, to discuss diagnosis and future intervention Provided transport, if necessary

20. 20 Pipeline to monitor referral process 20 Diagnosis: 1. Primary diagnosis 2. Secondary diagnosis 3. Diagnosis Date Intervention: 1. was their recommended intervention 2. Was intervention being carried out Evaluation of child: 1. Evaluated by 2. Evaluation date 3. Evaluation location. Diagnosis Received: 1. Initial Diagnosis or second opinion needed Initial Assessment: 1. Assessment Date 2. Assessed by Referral: 1. Referred to 2. Referral date 3. Referred by

21. 21 What did we want to know: Research Questions 21 1. Were our referrals appropriate? 2. Did children attend their appointments? 3. What was the time lapse between the time the child was referred and the time that the child was seen by a specialist? 4. Is the recommended intervention happening back in the community setting

22. 22 Analysis of the database 22 97% of children had appropriate referral 66% children attended their appointments Average 140 day time lapse (approx. 4 ½ months) between the referral and attendance of appointment 47% cases indicated that intervention was happening back in community (mainly referral to special units) One group of children we identified as difficult for us to know to whom we should refer

23. 23 Fourth: Intervention 23 Care-givers not always carrying out exercises and recommended work at home ( No home support) Preschool staff often unaware of interventions recommended Referrals to Special Schools often successful unless local issues (i.e. transport/school fees) and then child would return to original preschool

24. 24 Early Childhood Development Centre 24

25. 25 Addressing this issue: parent centre 25 Identification of special needs? Referral System Initial question: What is the need of the family? Intervention :Ikamva Labantu Staff to partner with specialist groups to provide on-site intervention

26. 26 Early identification must be included in basic holistic services Early identification is essential for… Prognosis of Individual Improved Service Delivery Equality throughout Society

27. 27 The Centre stands for a best practice model, ensuring children become lifelong learners