1. Education support services and health promoting schools
Dr Trish Struthers
Physiotherapy Department, UWC
Good morning ladies and gentlemen.
I will be talking about the education support services and health promoting schools.
The health promoting schools framework
Health Promoting Schools Conference 2006

2. Overview Inclusive education system
Health promoting schools framework
Education support services
In this presentation I will be exploring the important roles of the education support services in developing an inclusive education system.
I will discuss the use of the health promoting schools framework to provide appropriate support.
Health Promoting Schools Conference 2006

3. Inclusive education policy
Principles of human rights and social justice
Access to a single inclusive
education system
Vision of an inclusive
education system
Equity and redress for learners
excluded in the past
The vision of an inclusive education system that has been described in South Africa is based on the principles of human rights and social justice that the Constitution is based on. The policy documents of the Department of Education advocate for all learners to have access to a single inclusive education system. Emphasis is placed on equity within the education system and redress for learners who were previously excluded from education.
NCSNET/NCESS Report (Department of Education, 1997)
Education White Paper 6 (Department of Education, 2001)
Health Promoting Schools Conference 2006

4. Education White Paper 6 (Department of Education, 2001)
All children and youth can learn
& all children and youth need support
All learners are different
& have different learning needs
Education
White Paper 6
Change attitudes, behaviour,
teaching methodologies,
curricula & environment
to meet the needs of all learners
An inclusive education system acknowledges that all children and youth can learn and that all children and youth need support.
All learners are different and have different learning needs. It is a system that respects diversity, including diversity amongst learners and teachers.
If the needs of all learners are to be met there will need to be many changes in the education system. These include changes in the attitudes and behaviour of learners, teachers and parents. There will need to be changes in the teaching methodologies and the curricula. The physical and psychosocial environment of the school will need to change. Education needs to be an empowering experience that enables learners to participate to their maximum at school, at home and in the community.
To enable this to happen we need to to uncover and to minimize the barriers to learning.
Uncover & minimize barriers to learning
Health Promoting Schools Conference 2006

5. Is there a crisis in education?
Inequities in education
Poverty & socio-economic problems
Challenges to
implementing
inclusive
education
Teachers are overburdened
Difficult to adapt curriculum
Additional roles
& responsibilities
The newspapers are full of stories about difficulties in the schools. Does this reflect a crisis in education?
In interviews I did with teachers, most teachers were teaching classes with 45 learners in a class. They had heavy workloads, frequently worked weekends, and were experiencing stress.
They spoke of our inequitable education system.
One teacher remarked: If you look at our sister school at the other side of town, they have about one third of the kids that we’ve got and yet they have two or three speech therapists. It’s simply because they are on the other side of town … But you know, they’ve got the money and we’ve got the kids.
Poverty and socio-economic problems are major barriers to learning.
Teachers spoke of the impact of poverty on the parents and learners. Many learners attending the schools were from socio-economically disadvantaged communities with high levels of unemployment.
Many parents were seasonal worker on farms. This had a negative effect on the learners’ ability to attend one school on a regular basis as the families were frequently on the move.
The use of drugs by learners was also a problem related to the frequent use in the community.
Barriers to learning can also begin in the home. As one teacher said:
I visited his home. I then discovered there was something wrong because the parents were always fighting. So the problem was at home.
Teachers described feeling overburdened.
Some had difficulty adapting the curriculum for learners with intellectual disabilities:
One said:
We’re now talking of children with an IQ of between 65 and 75. These kids must now be placed in the mainstream and they must be accommodated, and I must tell you honestly that they are not coping very well at all.
One teacher spoke of how she adapted the demands of the curriculum to suit a learner who had AIDS:
I will beg him to write: “Why are you not writing?” Then he will just explain that he becomes tired, and so I have to accommodate that. So I’m trying all I can.”
Other teachers feared that Deaf learners would be teased by learners in ordinary schools and were concerned about the effect on the learner’s ability to progress academically.
Another teacher in an ordinary school spoke of the challenge of working with a learner with a speech difficulty:
And the other kids will just start giggling when the child starts to speak. It’s not easy for the kid and it’s not easy for me. Everybody feels uncomfortable. It must also have an effect on the child.
Additionally, in some ordinary schools there were learners who were 20 years old who were still in primary school. Their teachers indicated that they thought it was more appropriate to develop the learners’ life skills than to follow the standard curriculum:
I’m actually preparing them for the community so that they can look after themselves … they are being trained to be self-sufficient.
The teachers said their extra roles and responsibilities took away some of their teaching time.
They indicated that the time they had for teaching had been cut because of everything that they were now expected to do. In the schools that had access to therapists – the special schools – the therapists were not seen as a “support” for the teachers in facilitating learning, but as adding to their already heavy load. Teachers in special schools were concerned that tasks they felt belonged to the therapists were being passed on to them:
I must just say that as teachers, we do our utmost. We are not only teachers, but we are also physiotherapists, speech therapists and occupational therapists … and psychologists … Maybe we should get their salaries too. The work that the teachers must do is of such a nature that we should get paid for it as well.
They expressed the need for multilingual education support services personnel.
These pressures that teachers experience have led to opposition to the implementation of inclusive education:
They described how previously learners in special classes had had their own specially trained teachers, their own individual programmes, and received individual attention. The teachers said these learners were no longer as well prepared for life after school:
With this new system, you are definitely sending out more poorly equipped children than you did with the old system.
Feel unsupported
Opposition to inclusive education
Health Promoting Schools Conference 2006

6. How do we implement IE? The question is:
How do we bridge the gap between policy and reality, bearing in mind the significant challenges to the implementation of an inclusive education system?
So the question is
How do we bridge the gap between policy and reality, bearing in mind the significant challenges to the implementation of an inclusive education system?
Health Promoting Schools Conference 2006

7. The gap between policy and implementation
Implementation of
an inclusive
education system
GAP
Policy:
Vision of an inclusive
education system
Challenges to implementing
inclusive education
On the one side there is the policy and on the other side implementation, with the big gap in the middle with all the challenges.
Health Promoting Schools Conference 2006

8. Using the health promoting schools framework
Implementation of
an inclusive
education system
GAP
Policy:
Vision of an inclusive
education system
Health promoting schools framework
I am arguing that implementation of an inclusive education system is possible by using the health promoting schools framework.
Challenges to implementing
inclusive education
Health Promoting Schools Conference 2006

9. Health promoting schools framework
Based on WHO health promotion framework from the Ottawa Charter
This framework is based on the World Health Organisation framework that was put forward in the Ottawa Charter in 1986.
The health promoting schools framework
Health Promoting Schools Conference 2006

10. school –community network
Developing healthy
school environment
Developing healthy
school policies
Health promoting
schools framework
The fifth pillar of the health promoting schools framework is reorienting the education support services
Developing healthy
school –community network
Developing healthy
personal skills
The health promoting schools framework
Health Promoting Schools Conference 2006

11. education support services school –community network
Reorienting the
education support services
Developing healthy
school environment
Developing healthy
school policies
Health promoting
schools framework
The fifth pillar of the health promoting schools framework is reorienting the education support services
Developing healthy
school –community network
Developing healthy
personal skills
The health promoting schools framework
Health Promoting Schools Conference 2006

12. Education support services
community-based support systems
Parents & grandparents
NGOs
traditional healers
community-based rehabilitation workers
learning support teachers
occupational therapists
physiotherapists
speech & language therapists
psychologists
nurses
doctors
social workers
The education support services includes people
from within the school; from the district-based support team; and from the community
It includes the learning support teachers; occupational therapists; physiotherapists; speech and language therapists; psychologists; nurses; doctors; social workers; community-based support people such as traditional healers and community-based rehabilitation workers.
The health promoting schools framework
Health Promoting Schools Conference 2006

13. Build district-based support teams
What does
‘reorientation’ mean
for the education
support services?
What does reorientation mean for the education support services?
The Department of Education describes it as:
A Preventive & developmental approach
to the provision of support including
the development of health promoting schools
Preventive & developmental approach
to the provision of support including
the development of health promoting schools
The health promoting schools framework
Build district-based support teams

14. Healthy policy
Developing school policy that supports and promotes well-being including:
Access to school
Access to education support services
Access to assistive devices
Involvement of all learners in physical activity
Prevention of sports injuries
Accessible grounds, classrooms, toilets
The education support services can contribute towards developing healthy school policies that support and promote well-being
Examples of policies that they may be involved in developing include
Ensuring that all learners get access to school
Ensuring that all schools get access to the education support services
Ensuring that learners who need assistive devices such as wheelchairs, crutches or hearing aids get access to them
Ensuring that all learners at school are involved in physical activity
Ensuring that teachers are aware of ways of preventing sports injuries and ways of dealing with them when they occur
Ensuring that the school grounds and classrooms are accessible, for example for a learner, teacher or parent who is in a wheelchair
The health promoting schools framework
Health Promoting Schools Conference 2006

15. Healthy environment
Creating a safe & supportive teaching & learning environment
physical environment of the school
classroom environment
psychosocial environment
Discrimination: disability, social class, race, gender
Self-esteem
The education support services can also contribute a lot towards creating a safe and supportive teaching and learning environment.
Physiotherapists and occupational therapists can give support to teachers related to the physical accessibility of the school and classroom.
Occupational therapists and speech and language therapists can offer support in the classroom environment including advice on the development of life skills or communication skills.
Psychologists, in collaboration with others from the team, can give support to all school personnel, to the learners and to the parents, to improve the psychosocial environment of the school. This includes addressing aspects of discrimination such negative attitudes to disability, social class, race or gender.
It involves building the self-esteem of all.
The health promoting schools framework
Health Promoting Schools Conference 2006

16. School – Community network
Strengthening community action & building the network between the school & the community
Developing school – parents relationship
Partnership
Advocacy groups (DICAG)
Identifying social determinants of health in community
The education support services can be involved in strengthening community action and building the network between the school and the community.
They can assist with identifying the social determinants of health in the community such as unemployment, substance abuse, and violence.
Many teachers I spoke to wanted to improve their relationships with parents.
It is an area that the education support services team may be able to facilitate. Therapists who work with individual learners also want to have more contact with parents.
The development of a partnership with the parents while avoiding the establishment of hierarchical relationships is important.
There are many advocacy groups that have been established by parents that the education support services can help teachers to network with. DICAG, the Disabled Children’s Action Group is one such important organisation.
The health promoting schools framework
Health Promoting Schools Conference 2006

17. Personal skills
Developing personal skills of all in the school community
Learners
Teachers
Non-teaching staff
Parents
 self-esteem & empowerment
Finally the education support services can become involved in developing the personal skills of all in the school community. This includes the learners, the teachers, the non-teaching staff and the parents.
The outcome of this needs to be the development of self-esteem and empowerment
The health promoting schools framework
Health Promoting Schools Conference 2006

18. Education support services
Inclusive education system
Whole school
development
Inclusive &
health promoting
schools framework
In summary
An inclusive and health promoting schools framework can be used for whole school development to facilitate the implementation of an inclusive education system.
I have described how the education support services through the district-based support team can facilitate the implementation of inclusive education through utilising the health promoting schools framework.
The health promoting schools framework
Support from district-based support team

19. Medical model  Health promoting model
Focus: normalise the individual learner
Direct support
Focus on individuals
Health promoting model
Focus: adapt environment to enable learner to participate in school & society
Indirect support teachers & parents
Focus on groups/population
However the education support services need to reorient the way they provide support.
In the past they have used a medical model of support and this needs to change to a health promoting model of support.
The medical model of support focuses on normalising the individual learner through giving direct (one-on-one) support to the learner. The focus is on individuals.
The health promoting model of support focuses on adapting the environment to enable the learner to participate in school and society. It uses indirect support by giving support to the teachers and the parents. The focus is on groups of learners. It is a population-based approach.
The health promoting schools framework
Health Promoting Schools Conference 2006

20. Shift from direct  indirect support
support services need to move from a focus on individual learners
to support for teachers and the system
so teachers can respond to the needs of learners
In summary the reorientation of the education support services is a shift from direct to indirect support.. It is a move away from a focus on individual learners to support for the teachers and the education system. It enables teachers to respond to the needs of learners.
The health promoting schools framework
Health Promoting Schools Conference 2006

21. Education support service is inequitable
Public vs. private sector
Rural vs. urban areas
Provincial differences
Support from tertiary institutions
Unfortunately the education support service provision in South Africa is inequitable.
This includes the differences between the public and private sector; differences between the rural and the urban areas; difference between provinces; and differing support from tertiary institutions.
The health promoting schools framework
Health Promoting Schools Conference 2006

22. Therapists working with children in Western Cape per education district72 33 70 86 26 34 7
Central Metropole EMDC (20%)
East Metropole EMDC (9%)
North Metropole EMDC (20%)
South Metropole EMDC (25%)
Breede River/Overberg EMDC (7%)
South Cape/Karoo EMDC (7%)
Westcoast/Wineland EMDC (10%)
Unknown (2%)
350 Occupational therapists, physiotherapists
and speech & language therapists
EMDC=Education, Management and Development Centre
In a survey of therapists in the Western Cape, 350 indicated that they worked with pre-school and school-aged learners.
74% of them worked in the 4 education districts that lie in the urban Cape Metropole.
75% of the therapists were working in private practice.
Only 25% of the therapists were employed by the WCED or school governing bodies to work in the special schools.
Special schools in better resourced areas were able to employ additional therapists in governing body posts, generally funded by higher school fees.
This highlights the inequitable access to therapy between those who can afford private therapy, or a special school with higher school fees, and the majority of families who cannot.
However, the greatest need for support from therapists is in poorer communities where large numbers of children experience barriers to learning.
For example, in one education district there was only one part-time physiotherapist employed by the WCED in the whole EMDC, despite it being an area with the highest prevalence of Foetal Alcohol Syndrome in the world.
74% of therapists are in Cape Metropole (urban areas)
The health promoting schools framework
75% of therapists work in private practice
Health Promoting Schools Conference 2006

23. Way forward: Teamwork Within each education district Multidisciplinary
District-based support team
Multidisciplinary
Multisectoral
Education sector
Health sector
Social Development
Community people & organisations
Collaborative & partnerships
The development of the district-based support teams in each education district needs to be a priority.
Teamwork is the only way the acute shortage of education support service personnel can begin to be addressed.
Multidisciplinary and multisectoral teams need to be formed that include people from the education sector, the health sector, social development and from the community.
A collaborative approach is needed to build strong partnerships.
The health promoting schools framework
Health Promoting Schools Conference 2006

24. New health promoting role of district-based support team
Consultant-mentor for learner, teacher and parent
Understand purpose of support
Balance direct & indirect support
Part of interdisciplinary, intersectoral team
Healthy self-esteem
Team to support one another
A health promoting team
In this new health promoting role, the district-based support team can act as a consultant-mentor for the learners, teachers and parents. All need to understand the purpose of the support.
The balance needs to shift from direct support for individual learners to indirect support for the teachers and parents.
All in the district based team also need healthy self-esteem.
The team needs to give support to one another. It needs to be a health promoting team.
The health promoting schools framework
Health Promoting Schools Conference 2006

25. Measuring effective support?
Indicators?
What is the impact on learning?
Is the outcome empowering for the learners, teachers, parents?
Has the support been health promoting?
Indicators are needed to measure the impact of support on learning. Research is needed to identify if the outcome of support is empowering for the learners, the teachers and the parents.
The health promoting schools framework
Health Promoting Schools Conference 2006

26. Health promoting schools framework
The health promoting schools framework is an appropriate comprehensive approach to providing appropriate support to the school system, to the teachers, learners, and their parents
All in the district-based support team need competencies to provide support using this framework
The health promoting schools framework is an appropriate comprehensive approach to providing appropriate support to the school system, to the teachers, learners, and their parents
All in the district-based support team need competencies to provide support using this framework
The health promoting schools framework
Health Promoting Schools Conference 2006

27. I am a learner with a disability I am a learner who is HIV+
I also have the right to support which will enable me to learn
The health promoting schools framework
Health Promoting Schools Conference 2006

28. Health Promoting Schools Conference 2006
The health promoting schools framework
Health Promoting Schools Conference 2006

29. I am asking you …
I am asking you, the district-based support team, to provide me with support to enable me to learn at school
I need you to develop healthy policies & the inclusion of the health promoting schools framework in the policy documents of the Departments of Education, Health and Social Development
I need you to use the health promoting schools framework
I am asking you, the district-based support team, to provide me with support to enable me to learn at school
I need you to develop healthy policies & the inclusion of the health promoting schools framework in the policy documents of the Departments of Education, Health and Social Development
I need you to use the health promoting schools framework
The health promoting schools framework
Health Promoting Schools Conference 2006

30. I need your support …
I need you to help build a healthy physical and psychosocial environment at my school and in my local community
I need you to support me so I can learn and develop my knowledge and skills
I need you to support teachers, developing the links between the school and my parents and my community to enable me to be included in society
The health promoting schools framework
Health Promoting Schools Conference 2006

31. Health Promoting Schools Conference 2006
The health promoting schools framework
Health Promoting Schools Conference 2006

32. Health Promoting Schools Conference 2006
Thank you
The health promoting schools framework
Health Promoting Schools Conference 2006