1. EMILY VARGAS-BARÓN & ULF JANSON
with NATALIA MUFEL
EARLY CHILDHOOD INTERVENTION,
SPECIAL EDUCATION AND INCLUSION
FOCUS ON BELARUS

3. UNICEF
Regional Office for CEE/CIS
Emily Vargas-Barón & Ulf Janson
with Natalia Mufel
Early Childhood Intervention,
Special Education and Inclusion:
A Focus on Belarus
Minsk
«Altiora – Live Colours»
2009
I

4. UDC 376.1(476)(047.1)
Emily Vargas-Barón
Director
The RISE Institute
Washington, DC, USA
E-Mail: vargasbaron@hotmail.com
Ulf Janson
Professor
Department of Education
Stockholm University, Sweden
E-Mail: janson@ped.su.se
Natalia Mufel
Early Childhood Development Specialist
at UNICEF – Belarus Country Office
E-Mail: nmufel@unicef.org
currently – UNICEF, Cambodia
For further information, please contact:
Deepa Grover
Regional Advisor
Early Childhood Development
UNICEF
Regional Office for Central and Eastern
Europe and the
Commonwealth of Independent States
E-Mail: degrover@unicef.org
The opinions expressed in this document do
not necessarily reflect the policies or views
of the United Nations Children’s Fund. The
designations employed and the presentation
of the material (including maps) do not imply
on the part of UNICEF the expression of any
opinion whatsoever concerning the legal
status of any country or territory, or of its
authorities or the delimitations of its frontiers.
Photographs: Alexander Konotop
Typeset and layout: Dzianis Puhach
Proof reader: Dzianis Stulov
ISBN 978-985-6831-35-8 © Unicef, Regional office for CEE/CIS, 2009
II

5. The Project on child development, preschool and
school inclusion, and support to children
This study reviews early childhood with special needs and their families. He is a
intervention (ECI), special education and scientific counsellor to the National Board for
inclusive education programmes in Belarus. Social Affairs, Sweden, on issues of childhood
Upon the request of UNICEF’s Regional Office disability, member of the Coordinating
for CEE/CIS, it presents key programme Committee of International Society for Early
concepts and information, identifies lessons Intervention (ISEI), and member of the EU- and
learned, offers recommendations, and FIPSE-sponsored Transatlantic Consortium for
presents general Guidelines for ECI and Special Early Intervention. He has been a counsellor
Education Systems for the consideration of to the International Step-by-Step Association
other countries in the region and the world. (ISSA) and he collaborates with the
Department of Psychology at St. Petersburg
The Authors State University and the Early Intervention
Institute, St. Petersburg, in research and
Emily Vargas-Barón directs the Institute for development of preschool inclusion.
Reconstruction and International Security Publications in non-Scandinavian languages
through Education (The RISE Institute), include, except for scientific articles and
Washington, D.C. and Bogotá, Colombia. reports, contributions to Brambring & Rauh
She conducts research projects, advisory (Eds): Early Childhood Intervention, Research,
services and training in integrated ECD and Theory and Practice (1995) and Kreuzer &
education. From 1994 to 2001, she was a Ytterhus (Eds): Dabei sein ist nicht alles. Soziale
USAID Deputy Assistant Administrator and Inklusion und Marginalisierung in integrativen
directed USAID’s Center for Human Capacity Gruppen der Kindertagesstätte (in press).
Development. Previously, she founded
and directed the Center for Development, Natalia Mufel received her diploma in
Education and Nutrition (CEDEN, now called Psychology from the European Humanities
“Any Baby Can”), an ECI and ECD programme University in the Republic of Belarus. Her
serving families living in poverty in the U.S. studies include: postgraduate courses in
She also served as an Education Advisor for Belarusian State University (Psychology);
The Ford Foundation’s Andean Region and as Belarusian Post Diploma Medical Academy
a UNESCO Education Specialist. She has been (Psychotherapy of Children and Adolescents);
a professor at the University of Washington, Eastern-European Gestalt-Institute; and
University of Texas, Javeriana University, and Moscow Institute of Psychotherapy. She has
Sorbonne University. She holds a Ph.D. in experience as a researcher, psychologist,
Anthropology from Stanford University. She and lecturer in psychology, gender, child
is the author of many books and articles, development, reproductive health, family
including: Formative Evaluation of Parenting psychotherapy, and PTSD/crisis interventions.
Programmes in Four Countries of the CEE/CIS She has worked with working several
Region: Belarus, Bosnia & Herzegovina, Georgia multilateral, NGOs and governmental
and Kazakhstan, (2006 UNICEF) and Planning agencies. In UNICEF’s Belarus Office, she was
Policies for Early Childhood Development: the ECD Specialist and Focal Point for Health,
Guidelines for Action, published in English, Nutrition, Gender, Pre-school Education,
French, Spanish and Russian (2005 UNICEF, Stress Management, P2D and MICS3. Natalia
UNESCO and ADEA). is currently working as ECD Specialist in
UNICEF’s Cambodia Country Office.
Ulf Janson is a professor in Education at
Stockholm University, Sweden. He holds a
Ph.D. in Educational Psychology (Pedagogics)
from that university. He conducts research
III

6. Dedication
and Acknowledgements
This publication is We are grateful to Branislav Jekic, UNICEF • Larisa Nikolaevna Bogdanovich,
dedicated to the Representative for Belarus, and to Natalia Chief Physician, Brest Regional Medical
Mufel, UNICEF Early Childhood Development Rehabilitation Centre “Tonus” for
children of Belarus Specialist, who arranged our site visits in children with psycho-neurological
and to the Belarusian Belarus and St. Petersburg and contributed diseases
specialists who help extensive information for this study. We • Tatyana Zhuk, Director, Brest Regional
them achieve their also thank Deepa Grover, UNICEF Regional Developmental Centre of Special
potential. Adviser for Early Childhood Development, Education
who initiated this study, shared many • Irina Evgenievna Valitova,
resources, and joined us in St. Petersburg. Head, Developmental Psychology
Department of the Brest State
Special gratitude to these leading Belarusian University
and Russian professionals for their generous • Iryna Romualdovna Rumyanceva,
help: Director, Kobrin Development Center
of Special Education, “Alpha”
• Galina Vladimirovna Molchanova, • Ludmila Mihailovna Sheveleva,
Director of the Minsk Development Acting Chief Physician, Kobrin
Centre for Special Education, in Children’s Polyclinic
Correction and Development Training • Maria Ivanovna Samcevich, Head,
and Rehabilitation Centre Medical Rehabilitation Department of
• Victoria Vitalievna Troinich, Principal the Kobrin Children’s Polyclinic
Inspector of the Special Education • Tatyana Fedorovna Avdeichuk, Chief
Department of the Ministry of Physician, Brest Children’s Polyclinic #1
Education, Belarus • Oksana Evgenievna Trofimuk,
• Alexander Nikolaevich Yakovlev, Director, Development Center of
Chief Physician of the Minsk Medical Special Education “Veda”, Moskovskii
Rehabilitation Centre for children with District of Brest
psycho-neurological diseases • Elena V. Kozhevnikova, Director, St.
• Svetlana Mihailovna Eremeiceva, Petersburg Early Intervention Institute
Head of the Psychological Department • Natalia U. Baranova, Deputy Director
of the Minsk Children-Adolescents in Education, St. Petersburg Early
Psycho-neurological Dispensary, Chief Intervention Institute
Psychologist of the Minsk Health
Executive Committee Our warm thanks also to Sarah Klaus (OSF,
• Elena Titova, Chair of the non- London, UK), Elena Kozhevnikova (EII, St.
governmental organisation Belarusian Petersburg, Russian Federation), Deepa
Association of Assistance to Children Grover, Jean Claude Legrand and Severine
and Young People with Disabilities Jacomy Vite (UNICEF, RO CEE/CIS), for their
• Olga Grigoirievna Avila, Chief, Early thoughtful comments and enriching inputs
Intervention Centre in Minsk’s 19th that helped immensely to give final shape to
Polyclinic this document.
• Iryna Mihailovna Voitsehovich,
Speech Therapist, Early Intervention
Centre, 19th Polyclinic
• Oktyabrina Veniaminovna Doronina,
Psychologist, Early Intervention Centre,
19th Polyclinic
• Alina Anatolievna Nichkasova,
Psychologist, Early Intervention Centre,
19th Polyclinic
IV

7. Table
of Contents
Dedication and Acknowledgements .......................................................................IV
Table of Contents .......................................................................................................V
Preface.......................................................................................................................VII
Executive Summary ............................................................................................... VIII
Part I: Introduction .................................................................................................... 1
I.1 Early Childhood Intervention: an essential part
of all early childhood systems ..................................................................................................... 3
I.2 Objectives, limitations and scope of the study....................................................................... 4
Part II: Definitions, Conceptual Approaches and Context....................................... 5
II.1 General definitions and approaches to ECI............................................................................. 8
II.1.1 Child status..................................................................................................................... 8
II.1.2 Special education needs.............................................................................................. 8
II.1.3 Early childhood intervention...................................................................................... 9
II.2 Children with developmental delays or disabilities...........................................................10
II.2.1 Global rates of developmental delay and disability...........................................10
II.2.2 Services for children with special needs in CEE/CIS Region..............................11
II.2.3 Delay and disability in Belarus.................................................................................13
II.3 Continuum of early childhood services.................................................................................15
II.4 Defectology and special education.........................................................................................16
II.5 Inclusion issues...............................................................................................................................19
II.6 Continua regarding conceptual approaches to ECI...........................................................22
Part III: The Belarusian Support System for Families
with Special Needs Children....................................................................... 25
III.1 Overview of the system for ECI, special and inclusive education................................27
III.2 Introduction to health, medical and education services................................................30
III.3 Polyclinic-based Early Childhood Intervention Centres..................................................32
III.3.1 ECI Centre at Polyclinic 19, Minsk...........................................................................32
III.3.2 Polyclinic ECI Centre, Kobrin....................................................................................34
III.4 Child and Adolescent Psycho-neurological Dispensaries..............................................37
III.4.1 Psycho-neurological Dispensary, Minsk...............................................................37
III.5 Medical Rehabilitation Centres, MOH....................................................................................39
III.5.1 Medical Rehabilitation Centre, Minsk...................................................................39
III.5.2 Medical Rehabilitation Centre, Brest’s “Tonus Centre”......................................39
III.6 Development Centres, MOE......................................................................................................42
III.6.1 Development Centre, Minsk....................................................................................43
III.6.2 Development Centre, Kobrin’s Alpha Centre.......................................................44
III.6.3 Development Centre, Brest......................................................................................45
III.7 Infant Homes..................................................................................................................................47
III.8 Preschools for children with special needs, MOE..............................................................49
III.9 Belarusian Association of Assistance to Children and
Young People with Disabilities.................................................................................................52
V

8. Part IV: Lessons from Belarus and Recommendations.......................................... 55
IV.1 Main triggers and drivers of the ECI and Special Education System..........................57
IV.2 Lessons learned and recommendations for Belarus........................................................59
IV.3 Recommendations for training, exchange and networking.........................................66
Part V: Guidelines for Establishing ECI Services .................................................... 69
V.1 Introduction.....................................................................................................................................71
V.2 ECI Guidelines..................................................................................................................................72
V.2.1 Basic principles............................................................................................................72
V.2.2 Range of services.........................................................................................................72
V.3 Guidelines Chart.............................................................................................................................74
Bibliography............................................................................................................................................79
Annexes..................................................................................................................... 85
Annex I List of Acronyms..........................................................................................................85
Annex II Official Belarusian ECI Documents: Main Inter-agency
Agreements, Regulations and Guidelines.........................................................86
Annex III Map of the Republic of Belarus and Main Indicators and
Locations Visited by the Researchers..................................................................87
VI

9. Preface
Vulnerable children require early are presented in Part V. We look forward
childhood development (ECD) services to receiving your comments on these
to help them achieve their potential. suggestions.
However, ECD programmes in many
world areas aimed at serving vulnerable Because this review deals with many
children tend to be short in duration complex and sensitive issues, UNICEF felt
and they have general contents that are it was appropriate to create a two-person
more appropriate for typically developing study team that united our experiences
children. Abundant research has shown with ECD and ECI systems in Europe,
that effective services for vulnerable, high- Russia, Eastern Europe, the United States
risk, developmentally delayed or disabled and Latin America. With respect to
children should be more intensive, study methodology, we conducted an
enriched and longer in duration. extensive desk review of many studies
and documents, systematic observations
Providing intensive and enriched of programme services in action wherever
services for vulnerable young children possible, and probing interviews of
is sometimes considered to be overly many parents, programme directors and
expensive. After significant experience, personnel. We crosschecked information
we believe this to be untrue. New types extensively with a variety of sources to
of Early Childhood Intervention (ECI) ensure the greatest accuracy possible.
programmes for vulnerable children UNICEF personnel, and most especially
can be designed with varying levels of Natalia Mufel, provided extensive
intensity and richer curricula, learning information about the evolving ECI
materials and methods. In addition, system in Belarus.
better community outreach and child
assessment systems are needed to On a personal level, it was very rewarding
identify children with high-risk status, to work together and share ideas. We
developmental delays, malnutrition or hope our readers will agree.
disabilities. Improved and expanded
pre- and in-service staff training and Emily Vargas-Barón
combined supervisory, monitoring and Ulf Janson
and evaluation systems are required to
support programme development over
time.
As we shall show in this study,
investments in ECI, special education
and rehabilitation services are less
costly than institutionalising children,
and in addition, they are far more
humane, effective, child-centred and
family-focused.
Because most countries in the CEE/CIS
region have large health and education
systems, we believe they are poised
to develop ECI, special education and
inclusive preschool services. To enter this
next stage of programme development
for young children, we encourage
readers to review the initial Guidelines
for Early Childhood Intervention that
VII

10. Executive
Summary
Early Childhood Intervention, Special delays, malnutrition, chronic ill health or
Education and Inclusion: A Focus on disabilities.
Belarus describes and analyses a variety of To assess the wide variety of services for
programmes for vulnerable children with vulnerable children in Belarus, the authors
developmental delays and disabilities. created a heuristic device: “Continua
regarding Conceptual Approaches to ECI”
This study documents the evolution of that is presented in Section II.6. In Part
services for Early Childhood Intervention III, these continua were used to assess
(ECI), special education, and rehabilitation prevailing special health, medical and
for Belarusian children with special education services for young children
needs from birth to six or eight years in Belarus. These assessments revealed
of age. It includes definitions of key that a wide range of approaches is still
terms, including: developmental delays used and further evaluation research is
and disabilities; ECI services; special required to assess programme outcomes.
education; defectology; and “child-
centred,” “family-focused,” and inclusive In Part III, Chart III.1 Services for Special
services. It reviews the nature of services Needs Children in Belarus presents a
before the introduction of child-centred schematic overview of Belarus’ large and
and family focused approaches in recent impressive system of health, medical and
years, and it identifies some of the triggers education services. It then describes and
that prompted the modernisation of analyses the country’s main programmes
services as well as drivers that sustain for children with special needs, including:
programme quality and continuous • Polyclinic-based Early Child-
service improvement. The study focuses hood Intervention Centres;
on these programmes’ normative, • Child and Adolescent Psycho-
institutional and juridical status; structure neurological Dispensaries;
and organisation; general service • Medical Rehabilitation Centres;
coverage; and programme contents • Infant Homes;
and approaches. In addition, the • Development Centres of the
study provides some lessons learned, Ministry of Education;
recommendations for the CEE/CIS region, • A wide range of preschools for
and guidelines for ECI services. children with special needs;
and
Quandaries regarding prevailing • Family services of the Belarusian
global, regional and national rates of Association of Assistance to
developmental delay and disability are Children and Young People
also discussed. The current status of with Disabilities.
services for vulnerable children in the
CEE/CIS region is also reviewed, along In Part IV, a series of triggers and drivers of
with trends for moving from placement in the ECI and Special Education System are
state care institutions to providing child- identified. Major lessons learned gleaned
centred and family focused services for from this review of Belarusian services
special needs children and their parents. for young children with special needs
include:
In section II.3, a Continuum of Early 1. Strong policy support, a legal
Childhood Services is advanced as a basis for the ECI system, and
conceptual framework regarding ways inter-sectoral agreements and
countries can provide universal support guidelines promote the devel-
for families with young children as well as opment of sustainable, cultur-
more intensive and enriched services for ally appropriate, comprehen-
children with risk status, developmental sive and continuous ECI serv-
ices.
VIII

11. 2. Former defectological systems, preventive and supportive
concepts and methodologies child-centred and family-
should be revised to ensure based services for families
an effective special education with special needs children.
and health system can be The costs related to infant
developed. homes and orphanages
3. Service eligibility criteria should be progressively
should remain broad. shifted to the ECI and Special
4. Outreach services are essential Education System along with
to identify and serve all special the provision of high-quality
needs children. parent education and support
5. Inter-agency early identifica- services to ensure children
tion, assessment, case manage- will be well cared for and
ment, tracking and follow-up nurtured. Care must also be
systems are needed to ensure taken to ensure the transition
children are not “lost” in the is well programmed to provide
system. quality care in residential
6. Individualised family and child environments as children are
service plans should include gradually transitioned to new
the informed consent and foster homes or are adopted.
active participation of parents 17. In addition to current insti-
in all programme activities. tutional monitoring require-
7. Comprehensive centre- and ments, ECI services should
home-based ECI services design and implement results-
should feature the full range based programme evaluation
of service intensities plus systems in order to assess pro-
child care and respite care, as gramme outcomes.
needed. 18. Strategies for ECI programme
8. Year-round ECI services are advocacy are needed.
essential given continuous 19. In addition to public sector
child and family support needs. services, it is essential to
9. Belarusian parent education, provide support for NGOs,
counselling and support universities, professional
services have proven to be associations and other civil
effective and highly used by society organisations.
the parents of special needs 20. Basic research is needed on
children. child status, ECI systems and
10. Parent involvement in policy impacts.
ECI services and centres
is correlated with client In addition, recommendations are
satisfaction. provided for regional training, exchange
11. ECI’s Interdisciplinary Teams and networking in order to promote
helped to achieve well- the development of ECI services, special
integrated services. education programmes, and inclusive
12. Guidelines are needed to preschools in other countries.
manage ECI learning resources.
13. Careful planning for the In Part V, Guidelines for Establishing
transition of children and ECI Services are offered to help other
parents from ECI services countries design rights-based, child-
to inclusive preschools and centred, and family-focused ECI services.
primary schools is essential. These Guidelines include core concepts
14. Flexible approaches should and basic principles, structures and ranges
be used for pre- and in-service of services, processes and methodologies
personnel training. for establishing effective ECI services. The
15. Inter-agency coordination roles authors welcome comments on these
and Commission meetings Guidelines.
should be revised to ensure,
among other matters, that
parents are able to decide on
the futures of their children.
16. The cost of institutionalising
children with developmental
delays and disabilities far
exceeds the cost of providing
IX

12. 12

13. I
PART :
Introduction
1

15. Part I
Introduction
I.1 Early Childhood Intervention: an The incidence of developmental delays
essential part of all early childhood and disabilities throughout the world
systems is only beginning to be discovered. For
example, in the highly developed country
Programmes for early childhood of Chile, a nationwide assessment of
intervention (ECI), special education infant and child development revealed
and inclusive education should be high levels of developmental delay
an essential part of all national early in young children, especially among
childhood systems. Every society has families living in poverty. For infants from
many vulnerable children with special one to 23 months of age, delays varied
needs. These needs may be due to in municipalities from 23% to 40%. For
poor birth outcomes, war, poverty, children from 24 months to four years
famine, insufficient nurturing care, an of age, delays varied from 28% to 46%
impoverished learning environment, (Molina 2006). In response to these
poorly formed early relationships, alarming figures, Chile currently is placing
disease, chronic ill health, biological or a major emphasis upon developing ECI
chemical contamination, child neglect, services and inclusive preschool and
family genetics, domestic abuse, or the school education.
institutionalisation of “social orphans”1
and disabled children. Such vulnerable A series of studies on the rate of return
children require intensive ECI services on investment in ECD revealed that
that provide individualised attention to returns range from US $2 to $17 per dollar
meet their special needs. invested (Heckman et al 2000 – 2006).
Economists and national planners find
Brain research has demonstrated that it is these research findings most compelling.
imperative to provide supportive services As a result of these and other studies, on
for pregnant women and young children October 25, 2007, leading international
from birth to age three. During this economists participating in the Consulta
period, approximately 80% of the brain is de San Jose, identified ECD as the first
developed (Shonkoff and Phillips 2000). and most effective investment among
Most countries focus early childhood 29 priority areas for improving public
services for children from birth to age spending and policies in Latin America
three narrowly on primary health care, and the Caribbean. According to the
and only begin to invest in preschool outcome document:
education at age three or four. The critical
period of pregnancy to age three has Top priority was given to Early
been given relatively less attention. To Childhood Development programs.
date, most countries have not established These are interventions that improve
comprehensive early childhood systems the physical, intellectual and social
for parent education, early stimulation2, development of children early in their
and integrated services to meet an life. The interventions range from
array of child development needs, from growth monitoring, day care services,
high-risk and mild conditions to severe
malnutrition, developmental delays or 2 Parents and caregivers conduct early
disabilities. childhood stimulation and development activities,
beginning at birth, to optimize infants and
children’s perceptual, physical, mental, language,
and social and affective development. In this
study, infant stimulation is used to cover the full
1 Social orphans are children who are in range of infant and child development activities.
state care and without parental care, but who have It includes nurturing relationships, strong mother/
at least one living parent. child bonding, and the promotion of positive
socio-emotional development.
3

16. preschool activities, improved hygiene With respect to the scope of this study, Part
and health services to parenting skills. II includes a brief review of definitions and
Besides improving children’s welfare conceptual approaches to the fields of ECI,
directly, the panel concluded these an overview of “defectology” in relation to
programs create further benefits for special education and inclusive education
family members, releasing women as well as a discussion of prevailing rates
and older siblings to work outside the of children with special needs in the
home or to further their own education. world, CEE/CIS region and Belarus. Part
Evidence shows that the benefits are III provides an overview of the medical,
substantially higher than the costs.3 health and educational systems and
services provided for vulnerable children
I.2 Objectives, limitations and scope in Belarus. In Part IV, some lessons learned
of the study and recommendations are offered.
Finally, Part V presents general guidelines
The UNICEF Regional Office of CEE/ for the development of ECI services in the
CIS established the following study CEE/CIS region and elsewhere.
objectives:
1. To document the evolution of
centres for ECI, development
training and rehabilitation for
young Belarusian children from
zero to six or eight years of age
with special needs, including:
the nature of services before the
introduction of “child and family
friendly” approaches; triggers that
prompted the modernisation of
services; and drivers that sustain
quality and continuous service
improvement.
2. To characterise and assess ECI
systems and services in Belarus
with regard to: normative,
institutional and juridical status;
structure and organisation;
general service coverage; and
contents and approaches.
3. To develop general guidelines for
the establishment of effective,
rights-based, child-centred, and
family-focused ECI services in the
CEE/CIS region.
Although these objectives were attained,
this study has some limitations. We
had very limited time for field work.
Programme directors were universally
present during our relatively short visits
to each centre; in some sites professional
personnel were on vacation, limiting
opportunities to observe child, parental
and professional interactions. Most
materials were available in Belarusian or
Russian, and key documents had to be
translated for us. Several technical terms
and types of specialists were substantially
different from those used in other
countries. As a result, some terms have
been translated using rough equivalents
in English.
3 See website for additional
information: http://www.iadb.org/res/
consultaSanJose/files/outcome_eng.pdf
4

17. PART II:
Definitions, Conceptual Approaches
and Context
5

19. Part II
Definitions, Conceptual
Approaches and Context
In 2007, UNICEF established new children with more complex disability
programme guidance regarding Children appropriately.” (p. 9)
with Disabilities: Ending Discrimination Part II addresses definitions and
and Promoting Participation, Development conceptual approaches used to assess
and Inclusion. This guidance provides a and identify children with developmental
framework for ensuring all children will delays, malnutrition and disabilities, and
be given an opportunity to develop their to provide child-centred and family-
potential. It states: focused services. It also discusses
“Programming can incorporate global, regional and Belarusian rates of
attention to the issues raised by vulnerable children as well as reviews
childhood disability in different ways programme approaches developed in
across the life cycle. In the early years, CEE/CIS countries. Part II also presents
early detection and intervention, a general continuum of early childhood
as well as family support come to services and discusses issues regarding
the fore. Early intervention is critical defectology, special education and
and holds tremendous potential for inclusion.
success. It requires high awareness
among health professionals, parents,
teachers as well as other professionals
working with children. Family- and
community-based early intervention
services should be linked up with early
learning programmes and pre-schools,
which meet the needs of children with
disabilities and facilitate their smooth
transition to school. (p. 7)
“Efforts to incorporate attention to
children with disabilities in UNICEF
health and nutrition programming
should focus on improving strategies
for early detection, referral and
intervention and promoting equal
access to health services.” … “As
seen in numerous community-based
rehabilitation (CBR) programmes, early
screening and simple community-based
interventions by front-line workers
have shown to be an effective tool for
improving the lives and functioning
of persons with a disability... However,
early screening and diagnosis must
be linked to the provision of timely
and appropriate support and advice
to families, combined with the design
and orientation of a corresponding
intervention plan for more complex
problems and for developmental delays.
Efforts should focus on building the
capacity of health workers and others
in the community to provide advice and
assistance to parents, as well as to refer
7

20. II.1
General definitions
and approaches to ECI
Definitions and conceptual approaches Children develop in a holistic manner
are essential to understanding the fields and evolve dynamically over time
of ECI, special education and inclusive in response to their environments.4
education. The status of children targeted Because of this, both typically developing
by these programmes is a complex topic. children and those with developmental
They include children at high risk of delays or disabilities require balanced
developing delays or disabilities, children support in all areas of development,
that have developmental delays, and including perceptual, fine and gross
children with disabilities. motor, language, cognitive and social/
emotional development as well as
II.1.1 Child status health and nutrition in order to achieve
their innate potential. To achieve
Children who are at risk of developing balanced development, early childhood
delays and disabilities include those programmes use integrated approaches
with poor birth outcomes, biological that include basic services for preventive
or genetic risks, or whose parents live health care, nutrition, early nurturing,
in poverty, have low levels of formal stimulation and child development
education, or suffer from domestic activities, home and community
violence, substance abuse, violent sanitation, and in cases of special need,
conflicts, famine, diseases, poor sanitation juridical protection and protective
or other negative situations. services.
A child is considered to have a II.1.2 Special education needs
developmental delay when he or she
is assessed to have atypical behaviour Special education can be defined as
or does not meet expected normal educational and social services provided
development for actual or adjusted by preschools, schools and other
age in one or more of the following educational organisations to children
areas: perceptual, fine or gross motor, usually between the ages of two and
social or emotional, adaptive, language one-half or three years of age to 18 to
and communication, or cognitive 21 years of age. ECI services usually
development. A delay is measured begin before special education services
by using validated developmental are provided but in some countries, ECI
assessments. The delay may be mild, programmes are included within special
moderate or severe. Poor birth outcomes, education services, as is the case in
inadequate stimulatio and nurturing care Belarus.
from birth onward, organic problems,
psychological and familial situations, or The OECD classification of children with
environmental factors can cause delays. special education needs is as follows:
Cross-national category “A/Disabilities”:
A child is considered to be disabled if Students with disabilities or impairments
he or she has a physical, health, sensory, are viewed in medical terms as organic
psychological, intellectual or mental disorders attributable to organic
health condition or impairment that pathologies (e.g. in relation to sensory,
restricts functioning in one or more areas, motor or neurological defects). The
such as physical movement, cognitive educational need is considered to arise
and sensory functions, self-care, memory, primarily from problems attributable to
self-control, learning, or relating to these disabilities.
others. Many national and international 4 Holistic development refers to integrated
typologies of disabilities list impairments and balanced development in all areas, including
by type. physical, social, emotional, language and cognitive
development.
8

21. Cross-national category “B/Difficulties”: medical, nursing and nutritional
Students have behavioural or emotional services; and parent education and
disorders, or specific difficulties in support services, including referrals and
learning. The educational need is protective services, if required. They seek
considered to arise primarily from to identify high-risk, developmentally
problems in the interaction between the delayed, and disabled children at or soon
student and the educational context. In after birth or the onset of special needs.
the survey of special educational needs They also identify delays that appear
provision among member countries for later due to situations such as poverty,
school year 2000/2001, “mild mental lack of early nurturing and stimulation,
handicap” was changed from category B malnutrition, chronic ill health, war, loss
to category A. (OECD 2005, pp. 14 and 26) of parents, neglect, abuse, child labour,
and so forth. By focusing on children’s
Cross-national category “C/Disadvan- environments, ECI services help remove
tages”: Students have disadvantages aris- barriers to development in terms of
ing primarily from socio-economic, cul- social and educational conditions as well
tural and/or linguistic factors. The educa- as environmental adaptation and the
tional need is to compensate for the dis- provision of technical aids.
advantages attributable to these factors.
An additional ECI definition describes the
Although widely used, the OECD range of potential programme services
classification for children with special and impacts. For example, Shonkoff and
needs focuses on disability rather than Meisels state:
ability. It does not include learning “Early childhood intervention consists
opportunities from the removal of of multidisciplinary services provided
barriers or achievements that can result to children from birth to 5 years of age
from giving each child positive support to promote child health and well-being,
for attaining his or her potential. The enhance emerging competencies, minimize
early childhood intervention approach, developmental delays, remediate existing
presented next, stands in stark contrast or emerging disabilities, prevent functional
to this classification’s focus on disability. deterioration, and promote adaptive
parenting and overall family functioning.
II.1.3 Early childhood intervention These goals are accomplished by providing
individualized developmental, educational
Michael Guralnick defines early and therapeutic services for children in
childhood intervention “…as a system conjunction with mutually planned support
designed to support family patterns for their families.” (2000, pp. xvii-xviii) In essence, ECI
of interaction that best promote child programmes provide
development” (2001). From the parents’ ECI services usually begin at or shortly a system of early
point of view, Texas ECI services are after birth, and depending upon need, childhood services and
described as follows: “Children grow and should continue until developmental support for:
learn, or develop, a lot during their first three goals are achieved and consolidated, the
years. Although each child is special and child enters preschool or school, and/ 1) vulnerable
grows and learns at his or her own pace, or reaches six to eight years of age. The children at high risk
some children need extra help. This extra length of time ECI services are provided for developmental
help is called early childhood intervention.” varies from country to country: from birth delays or with
(Texas ECI Handbook 2006.) Shiela to three years of age, or from birth to confirmed
Wolfendale asserts that an ECI programme school entry or five to eight years of age. In developmental
has several goals: “Firstly, it is provided to countries with strong inclusive preschool delays or disabilities,
support families to support their children’s education programmes, ECI services often and
development. Secondly, it is to promote focus mainly on the critically important
children’s development in key domains such period of birth to three years of age. 2) their parents and
as communication or mobility. Thirdly, it is Where they exist, ECI services are usually families.
to promote children’s coping confidence, provided to both parents/families and to
and finally it is to prevent the emergence of children. For this reason, ECI services are The primary goal of
future problems.” (1997). universally family-focused and feature ECI programmes is
parent empowerment, education and to support parents in
ECI programmes include an array of support. When ECI, special education helping their children to
balanced activities with infants and and inclusive services are joined together, use their competencies
young children to encourage their inclusive services may continue until they to achieve their full
development in different domains reach 18 years of age. developmental potential
through a variety of methods: physical, and attain expected
language and occupational therapies; levels of development,
special education and inclusive services; to the extent possible.
9

22. II.2
Children with developmental
delays or disabilities
II.2.1 Global rates of developmental both physical and socio-cultural at-risk
delay and disability factors. Early childhood services are
particularly important for such children,
The global rate of developmental delay and contribute strongly to their health,
and disability is not known. Some social and cognitive development, as
estimate there may be 150 million well as to the social inclusion of their
children with disabilities alone worldwide, families and their future participation
indicating a prevalence rate of only in society. Moreover, these services fulfil
1.3%, which must be a vast undercount an early screening function in detecting
(Committee on the Rights of the Child special needs which, if identified
2006). The World Bank estimated that sufficiently early, can be treated more
40 million of 115 million out-of-school effectively, including the provision of
children have disabilities, including those support to families.” (Bennett 2006, p.
with moderate disabilities, and at least 92).
25% of the world population is affected In Starting Strong II, OECD’s Education
by disabilities. (World Bank 2003) The Directorate presents the following
numbers of children, who are at risk of statistics for OECD member countries
developmental delays or disabilities or using the categories presented earlier
are already affected by them, vary greatly regarding the frequency of varying levels
from country to country depending of risk, delay or impairment:5
upon: poverty rates; basic health care;
birth outcomes; parental educational and Category A/Disabilities: These are
economic levels and other circumstances. conditions that affect students from
Many more children are affected by all social classes and occupations,
developmental delays than originally generally around 5% of any OECD
thought, as demonstrated by the Chilean population.
national study of Dr. Helia Molina, noted
above. However, many national planners Category B/Difficulties: These learn-
believe that only a small percentage of ing disabilities are often temporary in
children are affected by delays, such as nature, and afflict a small percentage –
from 4% to 5%. This belief has been used around 1% – of any population.
as an excuse for neglecting to budget
adequate funds for essential health and Category C/Disadvantages: This
education services for children with is a large group in many countries
developmental delays or disabilities. ranging from 15% to 25% of children
in any given urban population.”
Regrettably, few countries have reliable (Paraphrased from Bennett 2006, pp.
counts of children with high-risk status, 97 – 98)6
delays and disabilities. Starting Strong II
states, 5 The OECD member states are: Australia,
Efforts to improve equitable access Austria, Belgium, Canada, the Czech Republic,
target primarily two categories of Denmark, Finland, France, Germany, Greece,
Hungary, Iceland, Ireland, Italy, Japan, Korea,
children: children with special needs
Luxembourg, Mexico, the Netherlands, New
due to physical, mental or sensory
Zealand, Norway, Poland, Portugal, the Slovak
disabilities; and children with Republic, Spain, Sweden, Switzerland, Turkey, the
additional learning needs derived from United Kingdom and the United States.
family dysfunction, socio-economic
disadvantage, or from ethnic, cultural
6 For Category C, due to a relative lack of
adequate health and education services, the rates
or linguistic factors. In practice, many
of developmental delay and disability in rural areas
children in need of special or additional
of OECD nations tend to be higher.
educational support have accumulated
10

23. In some parts of the Soviet Union,
Adding these rates together, from 21% to nursery care was less available; however,
31% of young children in OECD countries young children were usually placed in
are affected by/or at risk of developmental preschools in order to release mothers
delays or disabilities, a figure not totally to work outside the home. Infants and
dissimilar to Molina’s findings in Chile. young children who were considered to
This high level of need for ECI services has have a “defect” or other disability were
enormous implications for educational sent away to institutions and they rarely
achievement, social service costs, and were able to leave them during their
national productivity. lifetimes. Defectology was developed
as a discipline for identifying and caring
National coverage of special and inclusive for these children (See Section II.4).
education services that are enriched, Parent education was not provided,
more intensive, and longer in duration has and State responsibility for child rearing
been attained only in Australia, Europe, was emphasised while families were
New Zealand, North America and a few given a lesser role as helpers of State
countries of Latin America. These realities institutions. All of these circumstances
make the achievements of Belarus, a led to a situation where many present-
country in transition, all the more striking. day families do not esteem parenting and
Similar to many industrialised countries, lack basic parenting skills.
Belarus has developed a large ECI and
Special Education system. At the start of transition, several CEE/CIS
countries experienced major economic It can no longer be
II.2.2 Services for children with special and social dislocations and highly diverse sustained that ECI
needs in CEE/CIS region approaches to ECD arose, depending and special education
upon historical, institutional, cultural, programmes would
Before the founding of the Soviet Union, religious and economic circumstances. serve only a small
Russia had developed a wide variety of However, a few general statements may percentage of a nation’s
preschools. (For a rich discussion, see be made about the region as a whole. children in non-OECD
Taratukhina et al 2007.) However, after the Poverty indices rose sharply and in many countries. To ensure
October Revolution, private or otherwise countries, health, educational and social all children reach
independent preschools were ended services were severely curtailed, leading their developmental
or transferred to People’s Commissariat in most but not all countries, to a rapid potential, nations need
of Education. Thereafter, State-funded deterioration in primary health care, to target services to from
programmes provided centre-based preschool education, and many other 30% to over 50% of each
care for newborns and young children: social services upon which most families birth cohort. For nations
1) to enable mothers to work after two had become dependent. In addition, to meet their human
months of rest after childbirth; and 2) with privatisation, where national and/ rights commitments
to form children into citizens devoted or local governments did not mandate and become productive
to collectivist approaches wherein the maintenance of preschool services, and competitive in
individual creativity and initiative were coverage tended to decline precipitously. the world, it will be
not fostered (Zafeirakou 2006). Since 2000, many of these countries are necessary for them
recovering economically, and they are to establish policies
As noted by Taratukhina, “…the Soviet rebuilding and reforming their services and cost-effective
system was quite effective in dealing with for young children and their families. programmes for ECI and
the tasks set by the State. It was: stable; In general in the region, programmes special education as core
without competition; not arbitrary; settled for early childhood tend to have low elements of services
and in keeping with Russian habits and coverage and be directed and managed for early childhood and
mentality; a prop of the existing social by the public sector. In some cases parenting.
system; the same for all 15 component there is collaboration with civil society
republics of the USSR; centralized; without organisations, such as the Step by
right of initiative or independent decision Step NGOs established by the Soros
making; easy to manage from above Foundation Network, International Baby
because of its uniformity. From the mid- Food Action Network (IBFAN), and others.
1980s (the beginning of perestroika) there Increasingly, NGOs, universities, institutes
was a gradual transfer from a unitary and private initiatives are playing key
denationalized education system to roles in ECD in many of the countries.
a democratic, multiple and ethnically Residual pre-transition programmes
orientated education system. Russia saw and newly developed ones tend to be
the revival and qualitative improvement clustered in urban centres. Most CEE/
of national schools and the restoration of CIS countries are experiencing serious
humanist traditions in education. (p. 6) challenges in reaching rural areas and
excluded ethnic and linguistic groups.
The decentralisation of governmental
11

24. services has revealed a lack of capacity Specifically, the figure rose from 500,000
at municipal and community levels for children at the time of transition to 1.5
comprehensive ECD planning, including million children officially designated to
for ECI services. In general, as countries have disabilities in 27 countries. (UNICEF
have not formulated ECD policies, 2005 p. 2) This increase may not be real
plans, legislation, standards, evaluation, since it is surmised that countries have
quality assurance and accountability become more adept in recent years at
systems. Only a few countries have identifying and reporting disability.
developed incipient ECI systems. In this,
Belarus is leading the way through the In the former Soviet Union, most children
establishment of its large, varied and with disabilities were institutionalised.
quite integrated ECI and special education They were never seen, and if they were,
system. they became the object of discrimination
(Sammon 2001). Furthermore, when
In CEE/CIS countries, until recently children with disabilities entered
infancy to three was considered mainly preschools, they tended to be isolated
the responsibility of parents and and received a poorer quality of education
health care systems. There is growing and were unable to form social ties. When
acknowledgement of the need to segregated into institutions, they rarely
develop comprehensive ECD systems for were able to rejoin society during their
parents and children starting from the lifetimes. The 2005 General Comment
prenatal period. With respect to children Number 7 on the UN Convention on the
over three years of age, in Central Asia, Rights of the Child states, “Early childhood
preschool education declined after the is the period during which disabilities
fall of the Soviet Union; however by are usually identified and the impact on
2004, the preschool gross enrolment rate children’s well-being and development
had risen to 27%. In Central and Eastern recognized. Young children should never
Europe, gross preschool enrolments also be institutionalized solely on the grounds of
dropped but had recovered by 2004 disability. It is a priority to ensure that they
with an average gross enrolment rate of have equal opportunities to participate fully
57% in the region, with great variation in education and community life, including
among the countries. However, children by the removal of barriers that impede the
from the poorest backgrounds who realisation of their rights. Young disabled
stand to benefit most from ECD services children are entitled to appropriate
tend to be most likely to be excluded specialist assistance, including support for
from preschools. “Many children from their parents (or other caregivers). Disabled
ethnic minority groups are mislabelled children should at all times be treated with
as ‘developmentally delayed’ and lack dignity and in ways that encourage their
access to essential services.” (Sammon self-reliance.”
2001, p. 9) Better family income, majority
status, urban residency, higher maternal UNICEF estimates that about 1.5 million
education levels, birth registration, and children in the CEE/CIS region live in
the presence of an immunisation record, institutions and other out-of-home
are associated with the likelihood of care arrangements, and of them, at
preschool attendance in the region. least 317,000 had disabilities. These
(UNESCO 2006, pp. 3-6) In South East institutionalised children tend to be either
Europe, services for children from birth to disabled or among the most vulnerable,
three and for preschool education tend and in most countries of the region,
to be severely limited, especially for rural they usually lack access to ECD services
and excluded groups. (Zafeirakou 2006) and quality preschool opportunities.
A growing emphasis on social equity is Jonsson and Wiman estimate that in
leading to new ECD initiatives, and to Eastern Europe, 60% of all children
interest in developing ECI services in placed in institutions are disabled (2001,
countries such as Bosnia and Herzegovina p. 9). The study by UNICEF’s Innocenti
and Albania. Centre found that in the CEE/CIS, children
with disabilities have an 18% chance of
Countries of the CEE/CIS region use being institutionalised. Other typically
different definitions of disability, and developing children have only a 0.39%
systems for identifying children are chance of becoming institutionalised.
not well developed in most countries. Overall, they estimate that a child with
UNICEF’s Innocenti Centre estimated disabilities in CEE/CIS is 46 times more
that there had been a threefold increase likely to be placed in an institution
in children with disabilities between (UNICEF 2005).
the start of the transition and 2005.
12

25. A study in the Russia Federation revealed institutes that continue to prepare health,
that many children continue to be placed education and other professionals.
in institutions because their communities Populations tend to have higher levels
lack essential supportive services. They of formal education than many other
stated, “The health, education, and social world regions. The public health system
services necessary to permit children to has been weakened but it is still intact
remain in the community with their own in most CEE/CIS countries, and usually
family or with substitute families are it has retained some home visiting and
lacking. … The near exclusive reliance on polyclinic primary health care services
institutional care for children who require that could be improved and expanded to
support contributes to the disabilities of provide many ECI services. Although the
children. Research in child development number of preschools initially declined,
and the experience of other countries curricula and methods have been largely
around the world has demonstrated that revised, and preschool services are being
children experience developmental delays expanded in most countries. Options
and potentially irreversible psychological for avoiding institutionalisation are
damage by growing up in a congregate under consideration and new parent
environment. This is particularly true in the support services are being instituted
earliest stages of child development (birth in several countries. Vivid interest has
to age four), in which the child learns to been expressed in expanding inclusive
make psychological attachment to parents education and some inclusive preschools
(or substitute parents). Even in a well- and schools are being developed.
staffed institution, a child rarely gets the Countries are beginning to consider
amount of attention he or she would receive developing ECD policies and plans, and
from his or her own parents. Consequently, in many countries, they are taking an Poverty, family
institutionalisation precludes the kind of integrated and comprehensive view of problems, stigma, and
individual attachments that every child the early childhood field, including the a lack of information
needs” (Rosenthal et al 1999). Indeed provision of ECI and inclusive services. and community-based
UNICEF found that most children with options lead parents
disabilities in the region come from II.2.3 Delay and disability in Belarus to seek help from
poverty-stricken families. (UNICEF 2005, institutions.
p. 2) Definitions of developmental delay and
disability in Belarus differ from those In addition to highly
With support from international generally used by OECD countries. The detrimental effects of
organisations including UNICEF, the Ministry of Education (MOE) reports that institutionalisation on
World Bank, and the Open Society of the nearly 2 million children from child development,
Institute, among others, countries in the birth to 18 years of age, 125,981 children institutional care
region are working to de-institutionalise (6.3% of all children) are affected by is far more costly
children, and especially those with disabilities, and of them, approximately than community ECI
disabilities. (Tobis 2000) For example, 30,000 children (1.5% of all children) are programmes, inclusive
in the Former Yugoslav Republic of considered to be severely delayed or preschools, and
Macedonia, the Ministry of Labour and disabled. parenting services.
Social Policy (MOLSP) is developing new
policies and alternative care options Of the 125,981 children from birth to
such as community-based services age 18 reported to have disabilities, the
and day care centres. They are training following statistics are provided by the
personnel, reuniting children with their MOE:
families or placing them with carefully • Number of children identified
screened, selected and trained foster to have delays and disabilities,
families and developing small group from birth to three years of age:
homes where necessary (UNICEF 2007). 6,740
In general, countries of the region are • Number of children, four to five
looking for alternative, positive options to years of age: 33,943
institutionalising children with disabilities • Total children birth to six years of
and other social orphans, and they are age: 40,683
trying to go beyond the provision of
welfare payments and disability pensions The total number of children from infancy
for children. (UNICEF 2005) to six years of age was reported to be
632,913 for 2006, with 40,683 identified
Fortunately, the CEE/CIS region has to have a disability, yielding a disability
significant strengths upon which to build rate of 6.4% of the children less than six
its ECD and ECI services. Most of the years of age. This disability rate is virtually
countries have retained strong institutions identical to that of the general population
of higher education and technical of children from birth to 18 years of age.
13

26. This disability rate is slightly higher than Before transition, most children with
the general rate of 5% for OECD countries. disabilities were separated from their
families, placed in Infant Homes, and
Of concern is the major difference later transferred to orphanages. Today
between the numbers of children in Belarus, about 33,000 children are
identified to have disabilities from birth orphans or denied parental care. Many
to three years of age (6,740), in contrast of them have disabilities and do not have
to those who are from four to six years contact to a stable family. They remain
of age (33,943). Greatly expanded “invisible children” who are rarely seen
attention needs to be given to home in everyday life. These children with
and community outreach to identify all disabilities receive more developmental
of the infants and toddlers who are high- services than before but they lack loving,
risk, delayed or disabled. The MOE states stable parents. It was reported that many
that, in collaboration with the Ministry infants become social orphans especially
of Health (MOH), it serves virtually all because of the high 68% divorce rate. In
identified children. 2006, there were 73,000 marriages but
over 30,000 divorces. In Belarus there are
With respect to the types of disabilities over 355,000 single parent families, and
found in Belarus, the MOE reports the only 12,000 of these are father-headed
following: families. Because of the high divorce
• 74.5% have speech/language rate and related social issues such as
delays substance abuse, family violence, and
• 14.4% have “difficulties child abandonment, new family therapy
learning” programmes are being developed
• 13.8% have cognitive delays throughout Belarus.
• 11.0% have physical disabilities
• 5.0% have problems with In addition to family therapy, Belarus
eyesight or blindness is expanding its ECI and rehabilitative
• 1.6% have auditory challenges services, experimenting with special
• 2.6% have motor delays7 education and inclusive approaches
in crèches and preschools, and has
This list totals 125%, indicating that developed a country-wide parenting
some children have more than one education effort that is nested within all
type of disability. However, usually health, medical and education services
higher rates of multiple disabilities are that work with the parents of young
encountered, so these figures may be a children. The strong and supportive
large undercount. Also the proportion Positive Parenting Programme (PPP)
of speech/language delays seems to be that was developed with support from
extraordinarily large and cognitive delays UNICEF serves all programmes for young
quite low, for they often go hand in hand. children in Belarus (Vargas-Barón 2006).
Physical disabilities also seem to be low. To strengthen the PPP, the “Successful
Although the MOE has made a major Childhood Development Centre” was
effort to identify such children, additional officially inaugurated in 2007 with
work is needed to identify and categorise strong official support. This resource
disability. centre for the parenting programmes
is located in the Belarusian State
According to the 2005 Multiple Indicator University. A post-graduate university
Cluster Surveys (MICS) for Belarus, 3.8% of programme is also envisaged to prepare
children are born at or below 2,500 grams. early interventionists and upgrade
This rate is low but all of these fragile other specialists. In addition to general
children need special care to prevent parenting resources for specialists
long-term delays or disabilities. Because and parents of typically developing
of universal health service coverage, it children at low risk of developmental
should be fairly easy to ensure all such delays, several books and booklets for
children are promptly identified and parents of children with high-risk status,
referred for ECI services. Malnutrition developmental delays or disabilities, have
is rarely found in Belarus, and the MICS been developed, field-tested, produced
identified less than 1% of children with and distributed.
malnutrition.
7 A variety of assessment and screening
instruments are used. A standardised system
has not been established.
14

27. II.3
Continuum of early
childhood services
ECI services represent the most intensive as soon as possible in order to avoid
pole on a continuum of national-level the occurrence of serious delays. Many
early childhood services. The following children with developmental delays that
matrix refers especially to services for begin services at the most intensive end
children from birth to 36 months of age. of the continuum move to moderately
For children with high-risk status at birth intensive services within 9 to 12 months,
or potential developmental delays or and some will attain “normalcy” and
disabilities, it is essential that they enter then consolidate their gains through
ECI types of services soon after birth. participating in the least intensive services
Other children are identified after birth, listed at the right end of the continuum. Chart II.1: Continuum of
and they should be assessed and served Early Childhood Services
Service Intensity Most intensive Moderately intensive Least intensive
ECI + parent education & Focused ECI/ECD services + ECD services + parent educa-
Services Type of services
support parent education & support tion & support, as needed
High risk of developmental
Level of risk Moderate risk of delay Low or no risk of delay
delay
Very high risk of delay, in- Improved, mild delay, or only No delay or low to no risk of
Degree of delay
cipient to severely delayed at risk of delay delay
Disabled or at high risk of
Child Status Degree of disability Mild or no disability No disability risk
disability
Moderate to severe Mild malnutrition,
Nutritional status* Normal nutrition
malnutrition consolidating gains
Severe or chronic disease Improved health but still at Preventive & basic health
Health status
or illness risk status & care
Intensive, frequent child & Regular, less frequent child & Annual child & family
Assessments
family assessments family assessments assessments
Home & centre-based Centre-based, with fewer
Service locations Centre-based services only
services home visits
Frequent visits or sessions Less frequent (biweekly, Sessions upon request,
Service frequency
(daily to weekly) monthly) usually centre-based
Service Continuous services of Duration dependent on need Shorter, episodic & upon
Service duration
Aspects long duration & improvement request
Moderate (45 minutes to 1 Short, vary with parental
Length of sessions Longer (1 to 2 hours+)
hour) request
Early interventionists, ther- Early interventionists, supervi- Early childhood home visitors
Service providers
apists, nurses, physicians sion from therapists, others & parent educators, others
Roles of para- Assistants, home visitors, Assistants, home visitors, Supervised assistants
professionals supervised by specialists supervised by specialists & parent educators
* WHO standards for nutrition will be followed.
15

28. II.4
Defectology
and special education
Within the framework of intensive early child. It also employs other diagnostic
childhood services, during the 1920s, and nosological labels, which in the ECI-
the field of defectology, with Vygotsky8 perspective of today, are considered to be
as its pioneer, was established in the degrading, like “oligophren,” “moron” and
Soviet Union as a special discipline so on.
dealing with impairments, disabilities
and developmental delays. Although The deficit approach is logically related
Vygotsky was a precursor of modern to the orientation of goals for service
special needs education, his early writings provision and intervention, which is
on defectology were not followed. summarised in the term “correction.”
Later on, in its treatment applications, Diagnosis points to what is wrong, deviant
defectology developed into a correctional from normality, and the consequent
and socially segregating system. Children next step is to attempt to correct this
with delays or disabilities were closeted deviance. Correction is considered to be
away, and few rejoined society and a matter of treatment, training, therapy
their families (Rosenthal et al 1999). or compensation, and it is believed
To grasp the specific character of the that highly experienced and skilled
defectological orientation, in comparison professionals are required to accomplish
to the normative orientation underlying this treatment. Since this is considered to
the ECI perspective, it is important to pay be the case, laypersons are not generally
attention to conceptions held regarding seen as resources or as horizontally related
the child, service objectives, and key partners in intervention and support.
principles for the organisation and Parents are – at the most – receivers of
provision of services. prescriptions of regimes. Other children
are seldom seen as potential resources
In its conception of the child, defectology within the treatment plan. Inclusion, if
is oriented to deficits, rather than at all considered, is consequently judged
competencies. Assessment is considered from the perspective of treatment
to be solely a diagnostic procedure and training: if it leads to comparable
aiming at identifying deviances from correction outcomes it might be seen
what is assumed to be normal. The cause as an option. (In the case of preschool
of a special need, as well as eligibility for and school inclusion, such an outcome,
support, is thought of as a “pathology,” however, is rarely considered, because
in terms of physical, mental, sometimes special support is, with few exceptions,
also moral development, and the child not given within the mainstream school
is consequently conceived of as an context.).
“invalid.“ This can be contrasted with the
never ending, and sometimes ridiculed, Defectological service provision is
discourse about the “correct” way of organised as a highly specialised service,
terming a situation where the individual and it is usually centre or institution
child has a need for special support in bound. Identification of needs was, in
development, health, learning, social the early years, a task for regular medical
participation or whatever. While the health controls.
ambition, reflected in this discourse, is
to identify and understand disabling or
restrictive circumstances and barriers, and
concentrate efforts on removing them,
the defectological perspective frequently
uses the term ‘invalid’ to characterise the
8 Collected Works of L. S. Vygotsky, Vol II:
Fundamentals of Defectology (Abnormal Psychology
and Learning Disabilities). Kluwer 1993).
16