Current and preferred services of specialized professionals in childcare settings in Quebec, Canada: A descriptive survey of childcare administrators' perspectives.

BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.

The Effects of Enrolling in Oversubscribed Prekindergarten Programs Through Third Grade.

This study leverages naturally occurring lotteries for oversubscribed Boston Public Schools prekindergarten program sites between 2007 and 2011, for 3,182 children (M = 4.5 years old) to estimate the impacts of winning a first choice lottery and enrolling in Boston prekindergarten versus losing a first choice lottery and not enrolling on children's enrollment and persistence in district schools, grade retention, special education placement, and third-grade test scores. There are large effects on enrollment and persistence, but no effects on other examined outcomes for this subsample. Importantly, children who competed for oversubscribed seats were not representative of all appliers and almost all control-group children attended center-based preschool. Findings contribute to the larger evidence base and raise important considerations for future prekindergarten lottery-based studies.

Childhood Disability and Educational Outcomes: A Systematic Review.

PROBLEM: Graduation from high school is an important milestone for all adolescents and affects future health in adulthood. Children with chronic illnesses have additional challenges that affect school attendance, grade retention and graduation. If children with chronic conditions are not able to participate fully in education, this may limit their opportunities for future health. The aim of this study was to integrate the evidence in the past 28 years about educational outcomes of children and adolescents with chronic conditions causing disability. ELIGIBILITY CRITERIA: Quantitative studies reporting on a chronic condition and attendance, grade retention, or high school graduation, from a peer-reviewed journal in the English language, data collection since 1990, and research conducted with a population in the United States were eligible for review. SAMPLE: Forty-three studies from a literature search of CINAHL, MEDLINE, ERIC, Teacher Reference Center, Psychology & Behavioral Science Collection, and Academic Search Elite databases, followed by ancestry searches, were included in this review. RESULTS: In general, chronic conditions are significantly associated with increased absenteeism, grade repetition and not completing high school within four years, although hemophilia does not follow this pattern. Additionally, increased severity of the condition is associated with poorer educational outcomes. CONCLUSIONS: Nurses and other healthcare providers should include an educational assessment as part of psychosocial assessment of children and adolescents to identify risk, intervene early and limit risk.

Validity of the school setting interview for students with special educational needs in regular high school - a Rasch analysis.

BACKGROUND: Participation in education is a vital component of adolescents' everyday life and a determinant of health and future opportunities in adult life. The School Setting Interview (SSI) is an instrument which assesses student-environment fit and reflects the potential needs for adjustments to enhance students' participation in school activities. The aim of the study was to investigate the psychometric properties of the SSI for students with special educational needs in regular high school. METHODS: A sample of 509 students with special educational needs was assessed with the SSI. The polytomous unrestricted Rasch model was used to analyze the psychometric properties of the SSI regarding targeting, model fit, differential item functioning (DIF), response category functioning and unidimensionality. RESULTS: The SSI generally confirmed fit to assumptions of the Rasch model. Reliability was acceptable (0.73) and the SSI scale was able to separate students into three different levels of student-environment fit. DIF among gender was detected in item "Remember things" and in item "Homework" DIF was detected among students with or without diagnosis. All items had disordered thresholds. The SSI demonstrated unidimensionality and no response dependence was present among items. CONCLUSION: The results suggest that the SSI is valid for use among students with special educational needs in order to provide and evaluate environmental adjustments. However, the items with the detected DIF and the SSI rating scale with its disordered thresholds needs to be further scrutinized.

The role of special education teachers in facilitating peer relationships among students with mild intellectual disabilities in lower secondary school.

BACKGROUND:: Students with intellectual disabilities may lack sufficiently developed skills to initiate qualitatively good social interactions; thus, they might be in need of assistance. This study examined special education teachers' role in facilitating peer relationships among students with mild intellectual disabilities in a mainstream school context. MATERIALS AND METHODS:: The study was based on qualitative semi-structured interviews with nine special education teachers who belong to special education groups in lower secondary schools. A thematic structural analysis was used to identify themes. RESULTS:: The teachers made substantial efforts to promote social competence and ensure optimal conditions to foster peer interactions. An "academic-oriented" education, divergent attitudes, challenges in teacher collaboration, and organizational constraints may be barriers. CONCLUSIONS:: In a mainstream school, the role of special education teachers appears to be dependent on the basic values of the school management in terms of real opportunities to foster peer relationships among students with mild intellectual disabilities.

Experiences of parents of children with special needs at school entry: a mixed method approach.

BACKGROUND: The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. METHODS: Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. RESULTS: Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. CONCLUSIONS: While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry.

Stakeholders' views of the introduction of assistive technology in the classroom: How family-centred is Australian practice for students with cerebral palsy?

BACKGROUND: With family-centred care widely recognized as a cornerstone for effective assistive technology service provision, the current study was undertaken to investigate to what extent such approaches were used by schools when assistive technology assessments and implementation occurred in the classroom. METHOD: In this cross-sectional study, we compare survey results from parents (n = 76), school staff (n = 33) and allied health professionals (n = 65) with experience in the use of high-tech assistive technology. Demographic characteristics and the stakeholders' perceived helpfulness and frequency attending assessment and set-up sessions were captured. To evaluate how family-centred the assistive technology services were perceived to be, the parents filled out the Measure of Processes of Care for Caregivers, and the professionals completed the Measure of Processes of Care for Service Providers. Descriptive statistics and one-way analysis of variance were used to conduct the data analysis. RESULTS: Findings show that parents are more involved during the assessment stage than during the implementation and that classroom teachers are often not involved in the initial stage. Speech pathologists in particular are seen to be to a great extent helpful when implementing assistive technology in the classroom. This study found that family-centred service is not yet fully achieved in schools despite being endorsed in early intervention and disability services for over 20 years. No statistically significant differences were found with respect to school staff and allied health professionals' roles, their years of experience working with students with cerebral palsy and the scales in the Measure of Processes of Care for Service Providers. CONCLUSION: To enhance the way technology is matched to the student and successfully implemented, classroom teachers need to be fully involved in the whole assistive technology process. The findings also point to the significance of parents' involvement, with the support of allied health professionals, in the process of selecting and implementing assistive technology in the classroom.

Physio-psychological Burdens and Social Restrictions on Parents of Children With Technology Dependency are Associated With Care Coordination by Nurses.

PURPOSE: To determine the association between parental care burdens and care coordination provided by nurses for children with technology dependency, specifically regarding physio-psychological burdens and social restrictions. DESIGN AND METHODS: A cross-sectional study was conducted between October and November 2015. Participants were recruited via home-visit nursing stations, social worker offices, and special-needs schools. A total of 246 parents of children with technology dependency completed anonymous self-report questionnaires. Parental burden was measured using the Zarit Burden Interview. Care coordination for children with technology dependency was examined using items extracted from focus group interviews involving three nursing administrators at home-visit nursing stations, two social workers, and a coordinator of school education for children with special health care needs. Multiple regression analysis was performed to examine the relationship between parental burden and care coordination among 172 parents who contracted with visiting nurses. RESULTS: Parents and children with nursing support were significantly younger and had higher medical care needs and higher parental role strain than those without nursing support. Care coordination from nurses predicted reduced parental burden, role strain, and personal strain (ß=-0.247, p=0.002; ß=-0.272, p=0.001; ß=-0.221, p=0.009, respectively). CONCLUSION: Nurses' care coordination appears to be associated with a reduction in parents' care burden resulting from home medical care of children with technology dependency, especially the social restrictions and physio-psychological burdens. PRACTICE IMPLICATIONS: Strengthening nursing functioning as care coordinators may contribute to reducing care burdens for parents of children with technology dependency.

Special Needs: Scholastic Disability Accommodations from K-12 and Transitions to Higher Education.

The number of students entering post-secondary education with already diagnosed disabilities is on the rise and mirrors the percentage of children in primary and secondary public schools with registered disabilities. Requirements governed by civil rights laws fundamentally change when comparing the support schools have to provide to students during primary and secondary school with disability access in postsecondary higher education. Psychiatrists may be asked to assist with scholastic disability at any stage of education and need to know about available supports and the parameters of disability in schools. Specifically, special attention should to be made in preparation for transition to postsecondary education when prior accommodations exist.

Is a family-centred initiative a family-centred service? A case of a Conductive Education setting for children with cerebral palsy.

BACKGROUND: From the moment a child is diagnosed as having cerebral palsy, families have to cope on a daily basis with the multifaceted challenges of life-long disability management. Family-centred service is embraced as a 'best practice' model because of accumulating evidence supporting its positive influence on parents and children's outcomes. Nevertheless, research comparing parent and provider perspectives on family-centred practices of educational service providers in education settings is scarce. The aims of this study were to compare the extent to which parents and conductors experience the service delivery in Tsad Kadima, the Association for Conductive Education in Israel, as being family-centred, as well as comparing parents' perception of different educational settings as being family-centred. METHODS: Measurements of family-centeredness, the Israeli Measure of Processes of Care for families (MPOC-20) and for service providers (MPOC-SP), were administrated to 38 teacher conductors and 83 families of children with cerebral palsy (aged 1-14), from different conductive educational settings. RESULTS: Parents and conductors perceive Conductive Education service as being highly family centred in most domains, rating respectful and supportive care the highest and providing general information the lowest, thus indicating an area where improvements should be made. Parents perceived the service they receive to be more family-centred than conductor's perception about their own activities. In addition, educational setting (day care, pre-school and school) was found to be associated with parent's scores. CONCLUSIONS: The current study, which is the first to examine family-centred service provision in a conductive special education setting, from the perspectives of both parents and conductors, provides significant evidence for high-quality services in these settings.

A meta-synthesis of team members' voices: what we need and what we do to support students who use AAC.

The ultimate goal of AAC provision is to promote students' active participation across settings through interactions involving a variety of partners and functions. To achieve such outcomes, educational teams must collaborate and consider the characteristics of students, their families, and relevant environments during AAC assessment and intervention. To date, AAC team collaboration has rarely been evaluated collectively outside intervention or case study research. In this investigation, a meta-synthesis was conducted to review qualitative studies of perspectives of team members on supporting students who used AAC, ranging in age from kindergarten to post-secondary, in public schools in the United States. Analyses yielded three primary themes necessary for effective AAC services; inputs, activities, and outcomes. Implications and recommendations for service providers and future researchers are described.

Commentary: The Tyranny of Time and the Reality Principle.

Each of the five articles in this special issue gets "into the weeds" in terms of studying actual classroom or school implementation of evidence-based or promising practices. Virtually all confront the issue of logistics and establishing an infrastructure for ensuring adequate implementation. In general, those studies that ask teachers to change their practice, be it core classwide instruction (Wanzek & Vaughn, this issue) or the whole-class adolescent literacy interventions described in LaRusso et al. (this issue) experienced a good deal more in the way of implementation challenges than those that provided schools with extra services and were able to hire their own personnel to train and oversee as part of an efficacy trial. Yet, as anyone who has ever conducted an efficacy trial in the schools discovers, and Foorman et al. (this issue) remind us, research teams confront challenges never even mentioned in most research methods courses.

A lack of vision: evidence for poor communication of visual problems and support needs in education statements/plans for children with SEN.

OBJECTIVE: Visual dysfunction is more common in children with neurological impairments and previous studies have recommended such children receive visual and refractive assessment. In the UK, children with neurological impairment often have educational statementing for Special Educational Needs (SEN) and the statement should detail all health care and support needs to ensure the child's needs are met during school life. STUDY DESIGN: This study examined the representation of visual information in statements of SEN and compared this to orthoptic visual information from school visual assessments for children in a special school in Northern Ireland, UK. METHODS: The parents of 115 school children in a special school were informed about the study via written information. Participation involved parents permitting the researchers to access their child's SEN educational statement and orthoptic clinical records. RESULTS: Statement information was accessed for 28 participants aged between four and 19 years; 25 contained visual information. Two participants were identified in their statements as having a certification of visual impairment. An additional 10 children had visual acuity ≥ 0.3 logMAR. This visual deficit was not reported in statements in eight out of these 12 cases (67%). 11 participants had significant refractive error and wore spectacles, but only five (45%) had this requirement recorded in their statement. Overall, 10 participants (55%) had either reduced visual acuity or significant refractive error which was not recorded in their statement. CONCLUSIONS: Despite additional visual needs being common, and described in clinical records, the majority of those with reduced vision and/or spectacle requirements did not have this information included in their statement. If visual limitations are not recognized by educational services, the child's needs may not be met during school life. More comprehensive eye care services, embedded with stakeholder communication and links to education are necessary to improve understanding of vision for children with neurological impairments.

Barriers to supported education implementation: implications for administrators and policy makers.

The economic impact of a lack of educational achievement for individuals with psychiatric disabilities is profound. Current poor economic conditions exacerbate the effects of low educational levels. This article presents the current educational barriers faced by individuals with psychiatric disabilities and introduces one potential solution: supported education. Supported education is an emerging best practice which holds promise for helping individuals with psychiatric disabilities in their pursuit of educational goals. However, additional barriers stand in the way of widespread supported education implementation. Recommendations are included for policymakers and community mental health centers to help increase the penetration of this much-needed service.

Building statewide infrastructure for effective educational services for students with TBI: promising practices and recommendations.

OBJECTIVE: To identify promising practices in educational service delivery. METHODS: Consensus-building process with a multidisciplinary group of researchers, policy makers, and state Department of Education personnel. RESULTS: This white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support students with traumatic brain injury across the spectrum of injury severity: (a) identification, screening, and assessment practices; (b) systematic communication between medical and educational systems; (c) tracking of child's progress over time; and (d) professional development for school personnel. The white paper also presents key outcomes for measuring success and provides recommendations both for policy change and for furthering research in childhood brain injury.

Struggling to be seen and heard: the underserved and unserved populations.

OBJECTIVE: The purpose of this paper is to provide some current information on the topic of the underserved and unserved populations including modern-day slaves, stateless/displaced persons, refugees/migrants and indigenous populations. METHOD: Speech-language pathology education and services for the underserved as well as unserved populations are discussed. Three case studies which demonstrate knowledge transfer and exchange as potential models for future development are presented. CONCLUSION: These case studies lead to more inquiries, studies, innovations and involvement from individuals and groups who are concerned about the underserved and unserved populations.

Effective intervention for expressive grammar in children with specific language impairment.

BACKGROUND: Children with specific language impairment are known to struggle with expressive grammar. While some studies have shown successful intervention under laboratory conditions, there is a paucity of evidence for the effectiveness of grammar treatment in young children in community settings. AIM: To evaluate the effectiveness of a school-based intervention programme for expressive grammar in 5-year-olds with specific language impairment. METHOD & PROCEDURES: Thirty-four 5-year-old children attending a specialized school for children with language impairment participated in the study. Nineteen children received treatment for expressive grammar (experimental group) and 15 children received a control treatment. Treatment consisted of weekly 1-h sessions of small group activities in a classroom setting for 8 weeks. Techniques included direct instruction, focused stimulation, recasting and imitation. OUTCOMES & RESULTS: Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. There was a significant difference in grammatical performance pre- and post-treatment for children who received grammar treatment (Cohen's d = 1.24), but not for a group of children who received a control treatment. Further, no difference in performance was found in the equivalent time period prior to treatment, nor for an untreated target. Treatment success was more pronounced in children without articulation difficulties which interfered with their ability to produce the grammatical targets (Cohen's d = 1.66). Individual analyses indicated the treatment effect was significant for the majority of children. CONCLUSIONS & IMPLICATIONS: Individually targeted intervention delivered in small groups in a classroom setting was effective in improving production of expressive grammatical targets in 5-year-old children with specific language impairment.

The ambiguous role of the paraeducator in the general physical education environment.

The use of paraeducators has increased as a main mechanism to include more students with disabilities in the public schools in the U.S. Although the utilization of paraeducators is intended to be a supportive service delivery option, many concerns and challenges have resulted. The purpose of this study was to examine the role of the paraeducator in the general physical education environment from the perspectives of special education, physical education, and adapted physical education teachers and paraeducators. Data were collected from a phenomenological approach using questionnaires, interviews, and observations. Results indicate concerns about the clarity of the role of the paraeducator in physical education. Emerging themes include elastic definitions of student protection and teacher backup, contradictory expectations and mixed acceptance, and paraeducators' role ambiguity. Findings regarding the role of the paraeducator are essential in determining both best practice and legal policy for the appropriate utilization of paraeducators in physical education.

Creation and validation of the self-efficacy instrument for physical education teacher education majors toward inclusion.

The purpose was to validate a self-efficacy (SE) instrument toward including students with disability in physical education (PE). Three scales referring to intellectual disabilities (ID), physical disabilities (PD), or visual impairments (VI) were administered to 486 physical education teacher education (PETE) majors. The sample was randomly split, and exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted. After deleting items that did not meet inclusion criteria, EFA item loadings ranged from 0.53 to 0.91, and Cronbach's alpha reliability was high (for ID = .86, PD = .90, and VI = .92). CFA showed that the ID scale demonstrated good goodness-of-fit, whereas in the PD and in the VI scales demonstrated moderate fit. Thus, the content and construct validity of the instrument was supported.