Os sentidos produzidos por cuidadoras escolares de crianças com SCZV / Los sentidos producidos por cuidadores escolares de niños con SCZV / The senses produced by school caregivers of children with SCZV

RESUMO. Este estudo, fundamentado na perspectiva da psicologia cultural-histórica sobre a pessoa com deficiência, teve por objetivo apreender a dimensão subjetiva da realidade (ou as mediações) das crianças com a Síndrome Congênita do Zika Vírus (SCZV) no contexto escolar de desenvolvimento e aprendizagem a partir dos sentidos produzidos por cuidadoras escolares. Para tal, foram realizadas entrevistas semiestruturadas com três cuidadoras escolares que trabalham em três creches pertencentes ao sistema de educação de ensino de Campina Grande/PB. Para análise dos dados, foi realizado o procedimento dos Núcleos de Significação, que visa à apreensão das contradições que constituem as produções de significação discursiva dos sujeitos participantes. Os resultados indicaram que as cuidadoras escolares priorizam a mediação pedagógica na relação estabelecida com as crianças com SCZV, embora não desconsiderem a instância do cuidado em termos das necessidades especiais relacionadas à integridade psicomotora que essas crianças apresentam. Ademais, foi evidenciado que as participantes salientam as potencialidades das crianças em detrimento da falta ou lesão gerada pela deficiência.

RESUMEN. Este estudio, basado en la perspectiva de la psicología cultural-histórica sobre las personas con discapacidad, tenía como objetivo apreciar la dimensión subjetiva de la realidad de los niños con Síndrome Congénito del Virus del Zika (SCVZ). en el contexto escolar del desarrollo y el aprendizaje de los significados producidos por los cuidadores escolares. Para ello, se realizaron entrevistas semiestructuradas con tres cuidadores escolares de guarderías diferentes que pertenecen al sistema educativo de Campina Grande/PB. Para el análisis de datos, se realizó el procedimiento de los núcleos de significación, cuyo objetivo es aprehender las contradicciones que constituyen las producciones de significado discursiva de los participantes. Los resultados indicaron que los cuidadores de la escuela dan prioridad a la mediación pedagógica en la relación establecida con los niños con SCVZ, aunque no descuidan la instancia de cuidado en cuanto a las necesidades especiales relacionadas con la integridad psicomotora que tienen estos niños. Además, se destacó que los participantes ponen de relieve el potencial de los niños en detrimento de la falta o lesión generada por la discapacidad.

ABSTRACT This study is based by the perspective of the cultural-historical psychology on people with disabilities, aimed to apprehend the subjective dimension of the reality (or mediations) of children with Congenital Zika Virus Syndrome (CZVS) on the school context development and learning from the senses produced by school children caregivers. For this reason, semi-structured interviews were conducted with three caregivers working in three daycare centers belonging to the teaching system of education in Campina Grande/PB. For data analysis, was performed the meaning core, which aims to apprehend the contradictions that constitute the productions of discursive meaning in the participating subjects. The results indicated that school caregivers prioritize the mediation in the relationship established with children CZVS, though not disregard the instance of care in terms of the special needs related to psychomotor integrity that these children have. Furthermore, it was evidenced that the participants emphasize the children's potentialities to the detriment of the lack or injury generated by the disability.

Implementation and Perceptions of Classroom-Based Service Delivery: A Survey of Public School Clinicians.

Purpose The choice of service delivery model is important for public school clinicians. Despite a theoretical emphasis on inclusive classroom-based services, data from a recent American Speech-Language-Hearing Association Schools Survey indicated that the pullout model is still the more frequently used approach (American Speech-Language-Hearing Association, 2016). In the current study, public school clinicians' use and perceptions of inclusion were examined to better understand potential influences on its implementation. Method Three hundred forty-four school-based clinicians completed an online survey about their training in and implementation of inclusion services, along with their perceptions of positive and potentially challenging aspects of this model. Descriptive data were examined, and the relationships of use and perceptions to issues such as caseload size, training, school setting, teacher factors, and administrative support were analyzed. Additionally, qualitative analysis was used to examine responses to 3 open-ended questions. Results Over half of the respondents served 1%-25% of their caseload through an inclusion model, and it was most frequently utilized to address language and social skills. Teacher collaboration and planning time were the 2 most frequently reported keys to inclusion success and were also 2 of the most frequently reported challenges to implementation. Conclusions The majority of the respondents reported many positive aspects of inclusion, yet they also reported many of the same challenging perceptions and roadblocks that existed when speech-language pathologists were surveyed over 20 years ago. Based on the results of this study, training in the inclusion model, teacher "buy-in," planning time, and administrative support are relevant to successful use of classroom-based intervention.

"Together on the Way": Occupational Therapy in Mainstream Education-A Narrative Study of Emerging Practice in Switzerland.

In Switzerland, recent changes in legislation have reformed special needs education; more children with special needs are now integrated into mainstream schools. Health professionals such as occupational therapists are not embedded in the Swiss education system, but pediatric occupational therapists are starting to work at schools, with the aim of enabling children's full participation as school students. This is bringing a change to the practice of pediatric occupational therapists. Cultural, political, and social factors differ in many ways from those of other countries where most of the current research on pediatric occupational therapists in mainstream education has been conducted. The need for school-based research that is situated within the political, structural, and cultural context of a country has been stressed in different studies. This qualitative study employed narrative analysis to explore the practice experiences and clinical reasoning of Swiss pediatric occupational therapists when working with children with special needs in the school context. Three main themes were identified in the narratives: "bringing in an occupational therapy perspective," "focusing on school-related occupations," and "collaborating with different inclusion players." These represent three different aspects of the therapists' emerging practice. The participants highlight different approaches for children with special needs to enable their participation in everyday life at school through learning, playing, and being with their peers. The findings are discussed in relation to current international research and with respect to European countries with a similar political and structural context, thus complementing approaches to school-based occupational therapy.

A study into the effectiveness of a postural care training programme aimed at improving knowledge, understanding and confidence in parents and school staff.

BACKGROUND: Parents and school staff lack knowledge and confidence when providing postural care to physically disabled children. This can act as a barrier to the successful implementation of therapy. To address this problem, we developed a novel training programme to improve knowledge and confidence in providing postural care and evaluate the impact of the training programme in parents and school staff. METHODS: The postural care training programme included three elements: a 2-h interactive workshop facilitated by physiotherapists and occupational therapists, a follow-up home/school visit and a follow-up telephone call. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was utilized to evaluate the impact and includes subscales assessing knowledge and understanding, concerns and confidence in providing postural care. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was completed at baseline and 6 weeks later. The training programme was delivered to N = 75 parents and school staff. Of these, N = 65 completed both baseline and follow-up measures and were used in the data analysis. Participants and therapists were also invited to provide further feedback on the overall training programme via interviews and focus groups. RESULTS: Paired samples t-tests were used to determine statistically significant differences between baseline and follow-up scores for each of the three subscales. Mean levels of understanding and knowledge and confidence improved (P < 0.001), while concerns decreased (P < 0.001). Qualitative data were collected via interviews and group discussions providing an in-depth perspective on how participants experienced change. DISCUSSION: Results suggest improvement in knowledge, understanding and confidence in parents and school staff that care for children with significant physical postural care impairments.

Why chronically ill children face challenges in regular classrooms: perspectives from nursing teachers in Japan.

BACKGROUND: Chronically ill children are increasingly expected to join their peers in regular classrooms. However, sometimes schools do not provide adequate assistance. This study explores nursing teachers' thoughts and experiences on integrating such students into regular classrooms in Japan. METHODS: We analysed 79 essays written by nursing teachers collectively titled 'The challenges of having chronically ill children in regular classrooms'. We conducted a qualitative study using Kinoshita's Modified Grounded Theory Approach. RESULTS: Nursing teachers identified three main obstacles: insufficient resources to support chronically ill students, parents not playing a supporting role in aiding them at school and a regular classroom not being suitable for them. However, collaborating with the children's medical staff proved successful at integrating them into regular classrooms. CONCLUSIONS: Given these obstacles, it seems very difficult for nursing teachers to lead the way toward establishing cooperative support systems for the children. Instructions from medical staff could empower teachers to set up such systems.

Percepção de professores e gestores de educação sobre a inclusão de crianças com deficiência visual / Education managers and teacher's perception on the inclusion of children with visual impairment

Introdução: Deficiência visual é a perda de visão e interpretação de imagens visuais, com relação direta na qualidade do desenvolvimento global infantil. O programa de orientação e mobilidade escolar é um eficaz e importante facilitador na integração social e no sucesso escolar de crianças com deficiência visual. Objetivo: identificar a percepção de gestores educacionais e professores de crianças com deficiência visual na inclusão das mesmas no ensino regular, bem como suas dificuldades diretas durante o manejo pedagógico diário. Método: as etapas seguidas nesta pesquisa foram: construção e aplicação dos questionários; triagem das dúvidas dos participantes; reconstrução e reaplicação dos questionários. Resultados e Discussão: constatamos que as escolas de uma forma geral, não apresentam estrutura física que possibilitem a inclusão de alunos com algum tipo de deficiência, levando a riscos na locomoção dos mesmos ou limitando o acesso e permanência destes no ensino regular, sendo que 88% dos profissionais entrevistados não possuíam capacitação em educação especial. A falta de capacitação dos professores e ausência de adaptações na sala de ensino regular foram os principais responsáveis pelas dificuldades relatadas pelos professores para um eficiente processo de ensino aprendizagem associado à inclusão escolar. Conclusão: parte das crianças com deficiência visual está inserida no ensino regular, apesar das escolas não estarem adaptadas para recebê-las. Mas, sugere-se novas pesquisas levando em consideração opinião dos alunos com deficiência visual sobre os aspectos pesquisados, o seu grau de satisfação quanto o processo de ensino oferecido pela escola e sua orientação e mobilidade no âmbito escolar.

Introduction: Visual impairment is the loss of vision and interpretation of visual images, with direct relation on the quality of children's overall development. The guidance and student mobility program is an effective and important facilitator in social integration and the school success of children with visual impairment. Objective: identify the perception of education managers and teachers of children with visual disabilities in inclusion in regular education, as well as its direct difficulties during daily teaching management. Method: the steps followed in this research were: construction and application of questionnaires; screening of questions from participants; reconstruction and reapplication of the questionnaires. Results and Discussion: we found that schools in general, have no physical structure to enable the inclusion of students with a disability, taking the risks in getting them or limiting access and permanence of these in mainstream education, with 88% of respondents professionals they had no training in special education. The lack of training of teachers and lack of adjustments in regular education room were the main responsible for the difficulties reported by teachers for effective teaching and learning process associated with school inclusion. Conclusion: part of visually impaired children are placed in regular schools, although schools are not adapted to receive them. But it is suggested further research taking into account the opinion of visually impaired students on the aspects surveyed, their degree of satisfaction with the process of teaching offered by the school and its orientation and mobility in schools.

[School escorts in inclusive education- the current situation in the state of Baden-Wurttemberg]. / Schulbegleiter als Unterstützung von Inklusion im Schulwesen.

In the context of inclusive education, so-called «Schulbegleiter¼ (school escorts) have been installed to assist children with special needs. However, adequate conceptions of their role are lacking, and no provisions exist describing the exact tasks and duties of these school escorts. This article presents data on a statewide empirical study and provides information on the professional background, qualifications, and assignments of such escorts as well as the nature of the assisted children in the German state of Baden-Württemberg. The data were collected in nearly 50 % of all schools providing general education in Baden-Württemberg, and a total of 526 school escorts completed a questionnaire on their work. Children with special needs who received such assistance were aged 6 to 19 years (M = 10.4) and had a mental disorder in nearly three-fourths of all cases, with autism spectrum disorders being most common (59.4 %). The most frequent assignments of the escorts were providing practical assistance during classes and mobilizing the child as well as providing direct support in emotionally challenging situations. Such escorts can make a significant contribution to the inclusive education of disabled children. They do, however, need an adequate qualification and practical competences to meet the diverse challenges of children with special needs. Child and adolescent psychiatrists are supposed to stay involved in the process, not only by planning interventions, but also during the course of inclusive education itself. Thus, the emotional situation and adjustment of included children with mental disorders over time must be monitored adequately.

Inclusion in postsecondary institutions with small numbers of deaf and hard-of-hearing students: highlights and challenges.

This paper provides an examination of how small populations of deaf and hard-of-hearing (DHH) students attending New Zealand postsecondary institutions faced and dealt with various challenges in participating in classes, obtaining adequate access to services, and becoming socially integrated into campus life. Sixty-four students completed a survey and 8 were interviewed, providing information about their support needs, learning, and social participation experiences and challenges within the postsecondary context. Findings indicated that access to accommodations that facilitated communication and inclusion were critically important to their learning and participation experiences but were not always available in the institutions they attended. Reflecting recent policy and legislative changes, greater awareness and greater funding support are needed within New Zealand postsecondary institutions of DHH students' academic and social needs. This process should be at the forefront of moves toward inclusive education at the postsecondary level, if DHH students are to be equal participants.

Fifteen years of early hearing screening in Flanders: impact on language and education.

OBJECTIVES: To assess the impact of fifteen years of universal neonatal hearing screening in Flanders on language development and the educational setting. METHODOLOGY: An analysis of the database of Kind en Gezin from 1997 to 2012 and a long-term evaluation of the children referred to our centre after failed neonatal hearing screening. The CELF and PPVT language tests were performed. RESULTS: Between 1997 and August 2012, bilateral hearing loss was confirmed in 2393 children in Flanders, of whom 11.4% were referred to our tertiary centre. The educational setting and language development of 84 children older than 5 years was evaluated and 54% of them had additional disabilities. Of the children without additional disabilities, 84% attended mainstream schools; 42% of children with additional disabilities entered mainstream education with additional support. There was a significant correlation between the number of additional disabilities and the education level (p < 0.001) and between the degree of hearing loss and educational placement (p < 0.001). Data on language development were available for 76% of the children and a significant correlation could be demonstrated only between the results of the PPVT language and the number of additional handicaps (p < 0.008). CONCLUSIONS: The majority of children receiving early treatment after neonatal hearing screening enter mainstream education. The number of additional disabilities has a significant effect on education level and language development.

Training UAP to care for special needs students in the classroom: one district's approach.

As more children with complex medical needs are entering the school system, it may be appropriate for nurses to delegate some of the routine tasks to paraprofessional staff (Resha, 2010). With proper training, some non-complex daily treatments and many emergency procedures can be performed safely and effectively by UAP. NASN has several position statements directly related to this topic. Before a nurse decides to enlist unlicensed personnel for assistance, it is important to ensure that delegation of treatment is allowed under their school's policies and procedures as well as their state Nurse Practice Acts.

Using social capital to construct a conceptual International Classification of Functioning, Disability, and Health Children and Youth version-based framework for stronger inclusive education policies in Europe.

Inclusive education is part of social inclusion; therefore, social capital can be linked to an inclusive education policy and practice. This association is explored in this article, and a practical measure is proposed. Specifically, the World Health Organization's International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) is proposed as the link between social capital and inclusive education. By mapping participation and trust indicators of social capital to the ICF-CY and by using the Matrix to Analyse Functioning in Education Systems (MAFES) to analyze the functioning of inclusive education policies and systems, a measure for stronger inclusive education policies is proposed. Such a tool can be used for policy planning and monitoring to ensure better inclusive education environments. In conclusion, combining enhanced social capital linked to stronger inclusive education policies, by using the ICF-CY, can lead to better health and well-being for all.

Parent-Child Interaction Therapy (PCIT) in school-aged children with specific language impairment.

BACKGROUND: Parents play a critical role in their child's language development. Therefore, advising parents of a child with language difficulties on how to facilitate their child's language might benefit the child. Parent-Child Interaction Therapy (PCIT) has been developed specifically for this purpose. In PCIT, the speech-and-language therapist (SLT) works collaboratively with parents, altering interaction styles to make interaction more appropriate to their child's level of communicative needs. AIMS: This study investigates the effectiveness of PCIT in 8-10-year-old children with specific language impairment (SLI) in the expressive domain. It aimed to identify whether PCIT had any significant impact on the following communication parameters of the child: verbal initiations, verbal and non-verbal responses, mean length of utterance (MLU), and proportion of child-to-parent utterances. METHODS & PROCEDURES: Sixteen children with SLI and their parents were randomly assigned to two groups: treated or delayed treatment (control). The treated group took part in PCIT over a 4-week block, and then returned to the clinic for a final session after a 6-week consolidation period with no input from the therapist. The treated and control group were assessed in terms of the different communication parameters at three time points: pre-therapy, post-therapy (after the 4-week block) and at the final session (after the consolidation period), through video analysis. It was hypothesized that all communication parameters would significantly increase in the treated group over time and that no significant differences would be found in the control group. OUTCOMES & RESULTS: All the children in the treated group made language gains during spontaneous interactions with their parents. In comparison with the control group, PCIT had a positive effect on three of the five communication parameters: verbal initiations, MLU and the proportion of child-to-parent utterances. There was a marginal effect on verbal responses, and a trend towards such an effect for non-verbal responses. CONCLUSIONS & IMPLICATIONS: Despite the small group sizes, this study provides preliminary evidence that PCIT can achieve its treatment goals with 8-10-year-olds who have expressive language impairments. This has potentially important implications for how mainstream speech and language services provide intervention to school-aged children. In contrast to direct one-to-one therapy, PCIT offers a single block of therapy where the parents' communication and interaction skills are developed to provide the child with an appropriate language-rich environment, which in turn could be more cost-effective for the service provider.

Coteaching in physical education: a strategy for inclusive practice.

Qualitative research methods were used to explore the factors that informed general and adapted physical education teachers' coteaching practices within an inclusive high school physical education program. Two physical education teachers and one adapted physical education teacher were observed over a 16-week period. Interviews, field notes, and documents were collected and a constant comparative approach was used in the analysis that adopted a social model framework. Primary themes included community as the cornerstone for student learning, core values of trust and respect, and creating a natural support structure. Coteaching practices existed because of the shared values of teaching, learning, and the belief that all students should be included. Recommendations include shifting orientations within professional preparation programs to account for the social model of disability.

Challenging situations when teaching children with autism spectrum disorders in general physical education.

As the first step of an instrument development, teaching challenges that occur when students with autism spectrum disorders are educated in general physical education were elicited using Goldfried and D'Zurilla's (1969) behavioral-analytic model. Data were collected from a convenience sample of 43 certified physical educators (29 women and 14 men) using a demographic questionnaire and an elicitation questionnaire. Participants listed 225 teaching challenges, 46% related to cooperative, 31% to competitive, and 24% to individualistic learning situations. Teaching challenges were categorized into nine themes: inattentive and hyperactive behaviors, social impairment, emotional regulation difficulties, difficulties understanding and performing tasks, narrow focus and inflexible adherence to routines and structure, isolation by classmates, negative effects on classmates' learning, and need for support.

Children's beliefs toward cooperative playing with peers with disabilities in physical education.

Theory of Planned Behavior (Ajzen, 1991) was used to elicit salient behavioral, normative, and control beliefs of children without disabilities toward playing with a hypothetical peer with a disability in general physical education. Participants were 350 elementary and middle school students who completed two questionnaires. Questionnaires were assessed for content validity. Participants provided more affective (68%) than instrumental (32%) responses for favorable behavioral beliefs and more instrumental (76%) than affective (24%) responses for unfavorable beliefs. Peer social pressure was prevalent in favorable (69%) and unfavorable (99%) responses. Social pressure significantly varied across five grades, chi-squared(4, N = 448) = 40.51, p < .01. Participants responded many factors in the class would positively (76%) or negatively (89%) influence the behavior.

Speech and language therapy in Sure Start Local Programmes: a survey-based analysis of practice and innovation.

BACKGROUND: Sure Start has been a flagship policy for the UK Labour Government since 1998. Its aim was to improve the life chances of children under five years of age who live in areas of socio-economic disadvantage by means of multi-agency, multidisciplinary Sure Start Local Programmes (SSLPs). Speech and language therapists have played a key part in many SSLPs, and have had the opportunity to extend their roles. Despite the scrutiny paid to Sure Start, there has been no comprehensive analysis of speech and language therapists' contribution to date. Studies have focused on individual programmes or small samples: there has been no attempt to collate the full range of practice. As Sure Start evolved and Children's Centres emerged, it became vital to learn from the Sure Start experience and inform the mainstreaming of practice, before the window of opportunity closed. AIMS: The survey aims were, firstly, to identify the range of practice amongst speech and language therapists working in SSLPs, highlighting new practice, and, secondly, to categorize the practices according to the tiered model of UK health and social services of the Royal College of Speech and Language Therapists (RCSLT 2006). METHODS & PROCEDURES: An online mixed-method, semi-structured survey was designed to elicit primarily quantitative and categorical data. A total of 501 Sure Start Local Programmes were invited to take part. A total of 128 speech and language therapists responded, giving a response rate of 26%. A descriptive analysis of the response data was undertaken. OUTCOMES & RESULTS: A total of 103 respondents (80%) reported maintaining a clinical role as well as extending their roles to include preventative services. Of those 103 respondents, 69% were able to see referred children at a younger average age and 80% saw them more quickly than before Sure Start. A wide variety of preventative practice was identified. A widening of access to speech and language therapist was reported in terms of venues used and hours offered. Respondents reported on their use of evaluation or outcome measures, which was at a higher rate for new practice than for established practice. A total of 121 respondents (95%) reported at least one example of new practice; 103 (80%) reported at least one use of evaluation or outcome measures. The tiered model of UK health and social services provided an effective way of categorizing practice. CONCLUSIONS & IMPLICATIONS: A categorized record of Sure Start speech and language therapist is presented that may contribute to establishing a broad curriculum of practice for speech and language therapist in the early years. The effectiveness of the practices is not investigated: suggestions are made for further research to develop the evidence base.

Feasibility of a school reintegration programme for children with acute lymphoblastic leukaemia.

Despite children with acute lymphoblastic leukaemia missing a significant amount of school, little empirical literature guides the optimal content, setting and timing of a school reintegration programme. We examined the feasibility of a 4-month school reintegration intervention by: (1) developing collaboration with a community-based advocacy organisation; (2) developing intervention modules and observable end points; and (3) determining how the study achieved recruitment expectations. Eight families with children aged 6-12 years diagnosed with acute lymphoblastic leukaemia and parents were enrolled in the study. An experienced advocate implemented a series of eight modules over a 4-month period (twice per month) with the families. Participants completed pre-post measures. Successful collaboration with the advocacy organisation and the development of an intervention module series were achieved. Recruitment aims proved more difficult: enrolment was extended when recruitment for the original 1- to 6-month post-diagnosis window proved difficult. The advocate was able to complete between three and seven of the modules (mean = 5.2, standard deviation = 1.5). Families preferred clinic-based intervention. Challenges faced and lessons learned include: (1) advocacy organisations may be useful resources for school reintegration interventions; (2) school reintegration interventions must be flexibly applied; and (3) measurement end points constructed to gauge programme effectiveness.

The integration of children dependent on medical technology into public schools.

Advances in medicine have increased the survival rates of children with complex medical conditions, including those who are dependent on technology such as ventilators and tracheostomies. The process of integrating children dependent on medical technology into public schools requires the collaboration of a multidisciplinary team to ensure that both their educational and health care needs are met. As coordinator of the school health program, the school nurse plays a vital role throughout the integration process and during the time the student is enrolled in the school. This article presents a case study that demonstrates the steps in the integration process, the roles of the team members, and implications for school nursing practice.

Children who have complex health needs: parents' experiences of their child's education.

BACKGROUND: An increasing number of children have complex and continuing health needs. These children have the same right to a full range of education opportunities as other children. METHODS: This paper reports on the findings from a small qualitative study of the experiences of parents whose children have complex heath needs, related to their experiences of their child's education. Interviews with parents were used to generate data. FINDINGS: Parents encounter a number of challenges to their children achieving equal opportunities in relation to education. The factors which influence their opportunities include: staffing issues, funding issues, the attitudes of individuals and organizations, staff confidence in meeting children's needs, clarity over responsibilities and funding. For parents, what seemed most important is not whether their child accesses mainstream education, but whether the school which they attend assists them to achieve their potential. Children who have complex health needs may have to make a greater effort than their peers to achieve educational goals, and may miss considerable school time. This can impact on their leisure time. Accessing pre-school education can be difficult for children who have complex health needs. CONCLUSIONS: Inclusion in education should include pre-school provision, and more work in this area would be beneficial. Inclusion in mainstream education is only beneficial if it enables the child to participate fully with their peers. This requires practical and organizational issues to be addressed, services to be well co-ordinated, responsibilities and funding to be clear, and staff to be enabled to be confident in meeting the child's needs. However, it is also vital that individuals and organizations have a positive attitude to children and to inclusion. The additional effort and time which children may have to spend on their school work because of their health needs should also be recognized and supported appropriately.