Disability/Early Intervention

To change anything in this page, feel free to contribute directly or to propose revisions and amendments in the Discussion page. Use [square brackets] for anecdotes, comments or to raise questions.

Alternatively, insert them into this Google Doc: Section 1 Early Intervention

Overview

Summary

• [Tentative: Referrals and advice to caregivers from point of diagnoses was previously raised as inadequate, especially for ASD]
• [Tentative: Long wait lists for early intervention (EIPIC centres) and staff face burn-out.]
• [Insert summary statement]

Actionable Opportunity Areas

• [Insert opportunity area]
• [Insert opportunity area]

Knowledge Gaps

• Current information mainly focused centered on intellectual disability and autism; do other disabilities face similar issues with detection and early intervention? Eg hearing loss or other forms of sensory disabilities.
• [insert key knowledge gaps, see specific ones below]
• [insert key knowledge gaps, see specific ones below]

Key Statistics & Figures

Prevalence rate & trends

• 7,000 children aged 6 and below have developmental difficulties as of 2015 [Info gap: It is ambiguous from the TODAY article where this figure comes from, but potentially MSF]
• [Knowledge gap: How does the above square with the 10k students with special needs identified by SGEnable (see main page)? Does it mean that out of the 10k students iwth special needs, 7k are those under age 6?]
• [Knowledge gap: Out of the 7,000 how many have mild developmental needs (and therefore need DS/LS); how many have moderate to severe needs (and therefore need EIPIC)?]
• Between 2010 and 2014, KKH and NUH screenings show a 76% increase in children 6 and below with developmental issues such as development delays, speech and language delays, learning difficulties and autism spectrum disorders (ASD)
• [Knowledge gap: Are the rates of developmental disabilities going up, and to what extent might this be a result of better diagnosis?]

Theory of Change

The theory of change can be articulated this way: If children with issues are detected and diagnosed accurately with special needs, and referrals are adequate, then they can receive timely early intervention, better preparing them for school later on.

Key Programmes		Areas of Need & Desired Outcomes
Diagnostic Touchpoints & Referals	→	Detection, Diagnosis & Referrals Receive timely detection, accurate diagnosis & proper referrals	↘
DS / LS EIPIC programmes	→			Early Intervention [Insert outcome statement]	↘
SPED Mainstream Schools	→					Education (links to education page)

Areas of Needs / Desired Outcomes

Detection, Diagnosis & Referral

• Desired Outcomes: Children with special needs get timely detection, so that they might be referred to professionals for accurate diagnosis & proper referrals for follow-up services
• Synopsis: [Tentatively, it seems like proper referrals at diagnostic touchpoints are an issue, and also it is unclear whether teachers and caregivers pick up signs so that they send their children for diagnosis]

Existing Resources	Gaps	Possible Solutions
Detection "Parents whose children are suspected of having developmental issues are referred by paediatricians and doctors from outpatient private and public clinics offering primary healthcare services to the Child Development Units in KKH or NUH for a detailed assessment and diagnosis of the condition" (Singapore CRPD Report) This is usually a problem only for less visible disabilities. [Knowledge gap: What kinds of disabilities are hard to detect? What are the various places or touchpoints that might detect disabilities? Pre-schools, schools, polyclinics, caregivers themselves?]	[Knowledge gap: Are early childhood educators equipped to identify clients for diagnosis?] [Anecdote: Some people don't get diagnosed until much later in life, especially less visible disabilities like dyslexia]
Diagnosis & Assessment MOE: "Depending on the difficulties displayed, the school may recommend for your child to be assessed by psychologists from the Ministry of Education, or by professionals from a government hospital. Alternatively, your child can be assessed by a qualified private professional. If your child requires psycho-educational assessment, you can consider approaching an educational psychologist registered with the Singapore Register of Psychologists." Diagnostic Touchpoints: Psychologists from the Ministry of Education Professionals from government hospital: Children's Health Services, e.g. KKH Department of Child Development, NUH's Child Development Unit, Child Guidance Clinics Registered educational psychologists (for psycho-educational assessment) Private psychologists	[Knowledge gap: Any issues with accuracy, cost, accessibility, or quality of diagnoses?]
Referrals & Advice (from Diagnostic Touchpoints) MOE: "Assessment by qualified professionals should include clear recommendations for intervention and support. The assessment would help you to identify the type of support and education your child may require in the longer term, and also provide recommendations that you, and your child’s teacher, can implement at home and at school."	For caregivers of children with ASD, touchpoints are poorly equipped in advising parents on where to obtain reliable help during the post-diagnostic phase (see NCSS study, page 61 here)	Improve transition management (Recommendation 3, Strategic Direction 1 of EM3) For newly-diagnosed cases, to set up an agency to provide case referral, care planning and advisory services, and to facilitate smooth handover of information to other agencies [Clarification: Is this what SGE does now?] Includes developing a standardised case management tool between primary support agency and other service providers Enhance network of touchpoints to ensure timely and effective detection of developmental needs (Recommendation 4, Strategic Direction 4: of EM3) To make information and training more available to touchpoints (e.g., family, hospitals, polyclinics, family medicine practitioners, community partners) such as using electronic platforms, training primary care practitioners

Children’s Health Services

• KKH Department of Child Development [Source for the assertion that this programme has surveillance and diagnostic components?: "Provides early surveillance, diagnosis and interim intervention for preschool children with developmental needs, at the critical period of 0 – 6 years of age"]
• NUH's Child Development Unit
• IMH Child Guidance Clinics

Early Intervention

• Desired Outcome: Children with disabilities receive timely, affordable, accessible and effective early intervention. [Note for discussion: It is useful not to put down ideals that are impossible to achieve under the given circumstances but achievable outcomes that are the stated and shared aspirations of all relevant stakeholders]
• Synopsis: DS/LS is for mild developmental needs, and EIPIC for moderate to server developmental delays. While EIPIC serves around 3,200 children with mod-severe special needs, waitlists can extend from 6 months to 1 year. Further, early intervention professionals tend to have high turnover and quick burnout, due to unattractive remuneration compared to the private sector.

Programmes	Gaps	Ideas
For mild developmental needs Development Support (DS) & Learning Support (LS)	[Knowledge gap: can capacity of these services meet demand? What is quality of these services and their effectiveness?]
For moderate to severe developmental delays Early Intervention Programme for Infants & Children (EIPIC)	EIPIC Centres have long waiting lists (up to six months or a year) Early Intervention Professionals face quick burnout, unattractive salaries/benefits relative to the private sector and shortage of manpower	Long waiting lists at EIPIC Centres - (1) If disproportionately high at certain EIPIC Centres, to educate and counsel parents on their choice of centre or (2) scale up vacancies
Others Therapy for Children

Development Support and Learning Support

See SG Enable website on Development Support (DS) & Learning Support (LS)

• For pre-school children with mild developmental needs [Info gap: do we have figure for total number of such children?]
• Support and intervention in areas such as speech and language, social skills, motor skills, behaviour and literacy
• Rolled out to > 300 preschools, > 2,000 children and families, caa December 2015

Early Intervention Programme for Infants & Children (EIPIC)

See SG Enable websit on Early Intervention Programme for Infants & Children (EIPIC)

• Therapy and educational support services for children below 6 years with special needs at risk of moderate to severe developmental delays
• 21 EIPIC Centres, caa July 2018
• Currently serving about 2,600 children, projected to grow to 3,200 places by 2018
• Enhanced Pilot for Private Intervention Providers to subsidise selected Private Intervention Centres
• SPD - Building Bridges @ EIPIC Centres are at Tiong Bahru, Jurong, Tampines & Bedok served a total of 465 children in FY16/17 - 41 graduated, 27 progressing to mainstream primary and the rest to SPED

Therapy

• See SG Enable website listing social services agencies that provide different forms of Therapy

• KKH Child Development Programme has Inter-disciplinary and Trans-disciplinary Intervention services which include speech and language therapy, Occupational therapy, literacy intervention.