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Presented at ISEC 2000

The Efficacy Of Total Communication Within An Inclusive Education System For Deaf Students In Viet Nam

Ron Brouillette, Ph.D. CBMI Co-Worker, Technical Director, Viet Nam Inclusive Education


This presentation describes the advantages and disadvantages, difficulties and some successful strategies identified in mainstreaming Deaf and Hard of Hearing Students in 'hearing' classrooms in Viet Nam. It compares and contrast the development of the Vietnamese model with the inclusive education programs pioneered in Italy and the U.S.

The Inclusive Deaf Education project has designed and disseminated an enhanced Total Communication approach with an emphasis on Visual and Bilingual Education within ordinary classrooms. The presentation illustrates how educational attainment for the included Deaf students as well as their hearing peers defies the lack of optimal educational and specialised environments.

The Vietnamese model demonstrates the use of peer teachers, Deaf tutors, Sign Language development and training, community and educational based audiology, intensive in-service training of personnel and full community participation. Since August 1998, the Inclusive Deaf Education Project implemented by the Viet Nam Ministry of Education and Training (NIES) has provided mainstream education, audiological and support services to over 400 preschool and primary school students in 3 northern and 3 southern Provinces. There are an estimated 18,240 children who are hard of hearing (1 5,200) or Deaf children (3,040) in these provinces.

"The label 'mainstreaming' embraces so wide a range of educational arrangements that, as with the label 'total communication', people with divergent beliefs about deaf education can be gulled into endorsing it." Harlan Lane, The Mask of Benevolence

The shifting paradigm towards inclusion in developing nations will over time allow the 98% or so out of school deaf and hard of hearing children (d/hh) access to their local schools. While this evolution would in theory benefit those typically home-bound, young hearing impaired and their families, specialists in deaf education will be professionally affronted and members of the Deaf culture and academics like Lane will fear cultural genocide. To control potential damage to all concerned, the paradigm needs to be tested.

The purpose of this paper is 1) to redefine 'Total Communication' and 'Inclusive Education for d/hh children; 2) to analyze influential paradoxes or inconsistent anomalies inherent in the program for d/hh children and attempted solutions for these, and 3) to report the early results of an efficacy audit on the emerging Inclusive Total Communication program in Viet Nam.

Confusion still exists in defining 'Total Communication' and 'Inclusive Education'. Total Communication (TC) in the Vietnamese "Inclusive (Deaf) Education" context expands well beyond the original simultaneous communication roots (CASD,1976). Total communication is a philosophy that requires use of appropriate oral, manual, and speech modes of communication that would ensure effective communication. The TC philosophy when applied in the classroom had to expand by necessity the repertoire of communication approaches to appropriately respond to individual needs. Expanded TC approaches applicable to an inclusive classroom include writing, drawing, visual aids, mime, Visual Gestural Communication and every other means necessary to communicate (Moore, 1987, Lane, 1993, Carver and Kemp, 1998).

Inclusive Education in the Vietnamese context is at the far end of the integration - mainstreaming - inclusion continuum. Borrowing from Mary Warnock's terminology (DES, 1978) "integration" implies opportunities for occasional and locational mixing with hearing peers, "mainstreaming" suggests full-time functional mixing, while "inclusion" advocates social and societal mixing with hearing peers in school and the community at large. "Inclusive education is the placement of students with disabilities in their neighborhood schools in general education classes with peers their own age" (NASBE, 1995 reported in Fisher, Frey and Sax, 1999). Inclusive education is achieved as a result of the whole school and community's acceptance and celebration of individual differences (Lopez, 1996).

The practice of Inclusive (Deaf) Education Program in Viet Nam was initiated in September 1999 and currently supports 226 moderately to profoundly deaf students in regular or "hearing" classrooms in neighborhood schools in six rural provinces. A 10-minute video and posters are available that demonstrate the program.

Numerically, program accomplishments (see appendix) have come with relative ease due in part to sufficient funding and to the government of Viet Nam's unyielding adherence to an expanded inclusion ideology that nets Deaf students regardless of any Salamanca Statement. The greater challenge remains to obtain and sustain quality educational attainments, community acceptance and participation, and pride among bicultural Deaf students and their families.

The Inclusive Oxymoron - "Deaf Education in Hearing Classrooms"

At its inception, the program designers needed to factor into the national inclusive strategy three logical paradoxes inherent in system.

Paradox One: To provide quality education to mostly pre-linguistic severely deaf children within a crowded and noisy classroom that uses tonal language and few visual-teaching aids.

Paradox Two: To strengthen the Deaf culture and the language that binds it while removing and excluding deaf students from traditional, institutional enculturation.

Paradox Three: To facilitate the use of the government's newly preferred Total Communication approach in an oral classroom in a country where oralism has reigned for 25 years and no standard Sign Language let alone a sign-based code system exists.

Participation and Training As the Main Ingredients

Despite these idiosyncrasies, survey results suggest the teachers have taught as best they can and their less vocal students made some halting progress along path to literacy and self-confidence. Their parents are pleased. Perhaps some of the success can be attributed to the installation of control mechanisms to strengthen the Deaf culture and improve educational outcomes. Following initial social marketing to community gatekeepers, parents, educational administrators and teachers, the strategies employed to augment the Deaf-sensitive inclusive education included:

> Training and empowering a program support team of literate Deaf adults

> Training and motivating regular teachers

The idealism in the program runs high and the training formats vary. The 57 skill-trained Deaf adult tutors, Sign Language teachers and hearing aid technicians attended at least 8 days of leadership and Sign Language training assisted by Dr. James Woodward and Dorie Brouillette. In addition, Deaf adults received hands-on training during home and school tutoring and monitoring visits and during Saturday Social events at which parents, teachers and hearing Impaired students attended to learn from each other and participate in tutoring, Sign Language program monitoring and recreational activities. Naturally, it is not all roses. It is obvious that the Deaf adults are half-heartedly charitable with the program's strategy. Given a choice, the Deaf adults would ship the brightest deaf children to the handful of residential schools for the Deaf. These institutions openly compete with inclusive classrooms for these brightest students. This is part of the off-setting reality. During home visits, Deaf eyes quietly roll in protest when the Sign Language interventions are disrupted by a factory-fresh squealing hearing aid.

The teachers too object in similar silence to the extra load, their lack of preparation, time and salary incentives other than what the program can indirectly provide for what they do. The national center for special education NIES within the Ministry of Education is managing several programs and feel the need to be involved in the science of Vietnamese Sign Language development and academic teacher preparation courses. Teachers initially receive a10-day training course during the summer and a follow-up 10-day course in the second month of teaching followed by a planned 7 to 10 days course in the next summer. The strategy calls for an annual National Conference for Teachers of the Deaf to strengthen the profession. On the surface the program looks good. This subjectivity was recently validated.

Results from the preliminary Audit of Educational Outcomes

An educational audit survey was conducted to determine student progress for first academic year. Separate questionnaires in Vietnamese were given to principals; teachers and parents of hearing impaired children enrolled in regular classrooms in all 6 provinces. The survey constituted part of the mid-term evaluation for the USAID funded project. The 3-part survey to evaluate the students' progress and parent satisfaction was sent to all project provinces. Since schools closed and grades were to be submitted in mid June 2000, the response rate to date is 79%. Only 66 parents have so far responded yielding a 29% response rate. Only 21 principals out of 118 or so (some primary schools have as many as three teachers) responded to date -18% response rate.

Responses from the teachers (N = 134 out of 156 teachers for 86% response rate for the first two questions only)

1. The hearing impaired students' academic performance was slightly below average compared to his hearing classmates (2.12 with "Above average" ranked 4 "Average" ranked 3, "Below average" ranked 2 and "Failing" ranked 1: N = 134).

2. The hearing impaired student's social behavior was judged to be between fair and poor compared to the hearing students (1.50 with "Fair Social Behavior" ranked 2 " and "Poor" ranked' 1: (N = 120).

3. On average hearing impaired students participate in the classroom varied from often to sometimes (3.28 with "Often" ranked 4, and "Sometimes" ranked 3: N = 49).

4. The hearing impaired students made some friends in class (2.87 with "Some friends" ranked 3 and "Few friends" ranked 2: N = 58).

5. The seat-mates or peer tutors are able to use a little to some Sign or gestural language with the hearing impaired student (2.32 with "Some SL" ranked 3 and "Little" ranked 2: N = 49).

6. The other hearing students in the classroom use very little Sign or gestural language with the hearing impaired (1.87 with "Little" ranked 2 and "None" ranked 1: N = 46).

7. In the opinion of their teachers, 55% of the 58 hearing impaired students in the sample are prepared sufficiently to advance to the next class and 45% are not yet ready.

The main problems facing the teachers included:

Response from the Principals (N = 21 for 18% response rate)

The principals were asked to supply the grades of the students and comment on the students' performance in the inclusive classrooms. The sample of 21 principals provided the following responses:

1. The academic performance of the hearing impaired students is far worse compared to the hearing students (1.3 with "The same performance" ranked 2 and "Worse performance" ranked 1) N = 21.

2. The academic performance of the "inclusive" classroom compared to the cohort classrooms was judged by principals to be about the same to very slighter better than the other classrooms of the same grade level (2.1 with "Better performance" ranked 3, "The same performance" ranked 2, and "Worse performance" ranked 1). N = 21

Reported Reasons Why Inclusive Classrooms Were Reported To Be a Bit Better Than Non-inclusive Classrooms:

1) The strongest teachers who outperformed other classes had been selected for training in inclusive education,
2) Some better students are enrolled in the strongest teachers classroom,
3) More attention, training and visual aids given to the inclusive classroom ("halo effect").
4) The ablest hearing impaired students were admitted to and continued with school.

Many of the teachers privately confessed that their past outcomes are typically higher than the others. This year would also have been higher without the inclusion of deaf students.

Report from Parents (N = 66 of 226 students for 29% response rate)

The responses from the sample of 66 parents were strongly favorable to project outcomes.

  1. Asked if their hearing impaired child enjoys going to a hearing school all but 2 stated "very much" with a ranking of 4. The other 2 parents stated "Mostly enjoyed" with a ranking of 3: (N = 65).
  2. The child's quality of life was reported to have changed for the better by all but 3 of the parents (2.92 with "better" ranked 3 and "the same" ranked 2). The 3 divergent parents stated the quality of life was the same as before: (N = 56).
  3. The attitudes of hearing children in the home and neighborhood were far better than before the hearing impaired child attended school (2.85 with better ranked 3 and the same ranked 2: (N = 21).
  4. All the parents are willing to send their child to school next session. All but two parents responded with the "Very willing to send" ranked 3. These two parents stated "Somewhat willing" ranked 2. The parents gave no reasons for their responses.

While the parents expressed full appreciation for the program they also had some recommendations for program enhancements in the order of frequency of responses:


The Vietnamese model of Inclusive Deaf Education builds on the innate strengths of the Deaf and hearing communities. The project is in its infancy. Judging from the enthusiasm shown by the Deaf leaders and the hearing impaired children, their parents and the community, the program is already sustainable and will evolve. The deaf students are progressing in their education to become literate Vietnamese citizens in their bicultural world.

Set up two administrative offices and trained coordinators and key support persons for the northern and southern provinces,
Developed public awareness materials such as shirts, videos and posters,
Conducted study tours to the well developed deaf education facilities in the Philippines, and set up provincial demonstration centers in Viet Nam,
Provided 3 week in-service training courses to 270 teachers in regular preschools and primary schools and to 87 educational administrators,
Provided intensive training for 8 audiological technicians and 6 speech technicians and facilitated ear-mold making course
Developed a Sign Language dictionary (Signs vary between regions), instructional video tape, and A Picture - Sign vocabulary book
Prepared 57 Deaf teacher aids and Deaf Sign Language teachers,
Enrolled 226 children with varying degrees of hearing impairments and deafness into local schools. Of these, 178 are enrolled in regular primary classrooms 48 are attending local preschools in the six project provinces. Visited the mainstream teachers and students regularly to monitor needs,
Produced and analyzed 480 Behind the Ear and Body worn hearing aids from kits (SKD), assembled by Deaf adults at average cost of $46 each,
Tested over 1,600 children for hearing loss and fitted 160 hearing aids.
Organized home tutoring program using graded booklets and Deaf tutors to help newly enrolled Deaf students to catch-up with hearing peers
Prepared an ear care manual and posters for the prevention of hearing impairments and organizing a survey on ear and hearing disorders,
Developed sports and leadership training for deaf adults and held Deaf inter-school Sports competitions in northern and southern regions.


Brouillette, R. (1998). "Adapting Community- Based Approaches for the Deaf". In Amatzia Weisel (Ed.) Insights into Deaf Education: Current Theory and Practice. Tel Aviv: Academic Press.

Carver, R. and Kemp, M. (1998) Visual Gestural Communication: Enhancing Early Communication and Literacy in Yong Deaf and Hard of Hearing Children. In Amatzia Weisel (Ed.) Insights into Deaf Education: Current Theory and Practice. Tel Aviv: Academic Press.

Cohen, L. (1994) Train Go Sorry.. NY: Houghton Mifflin

Coleridge, P. (1993). Disability, Liberation and Development Oxford: Oxfam.

Conference of Executives of American Schools for the Deaf (1976). American Annals of the Deaf, 1976, 121,4.

Cornoldi, C, Terreni, A, Scruggs, T and Mastripieri, M (1998) Teacher Attitudes in Italy After Twenty Years of Inclusion. Remdial and Special Education. Vol. 19, Number 6, pp 350-356.

DES (Department of Education and Science) (1978) Special Education Needs (Warnock Report). Cmnd 7212. London: HMSO.

EENET (1998) "Focusing on Community Support for Inclusive Education". EENET Enabling Education. Issue 2 October 1998, Manchester: EENT University of Manchester.

Fisher, D, Frey, N, Sax, C (1999) Inclusive Elementary Schools: Recipes for Success. Colorado Springs: PEAK Parent Center.

Higgins, P. The Challenge of Educating Together Deaf and Hard of Hearing Youth: Making Mainstreaming Work.

Immanuel, S. P., Agnes, L. (1998) Community-Based Services for People with Hearing Impairment. In Immanuel, Koenig and Tesni (Eds.) Listening to Sounds and Signs: Trends in Deaf Education and Communication. CBM and Books for Change: Bangalore.

Kreimeyer, K. (2000). "Academic and Social Benefits of a Co-enrollment Model of Inclusive Education for Deaf and Hard of Hearing Children". Journal of Deaf Studies and Deaf Education. Vol 5, No. 2 Spring 2000.

Lane, H. (1993). The Mask of Benevolence: Disabling the Deaf Community. New York: Vintage Books.

Lopez, Irene (1996). Inclusive Education: A comparison of the Vietnam and Sri Lanka experiences. ACTIONAID DISABILITY NEWS. Vol 7, No. 2 1996.

Mangiardi, A. (1993). A Child with Hearing Impairments in Your Classroom? Don't Panic. Washington, D.C.: AG Bell.

McAnally, P. Rose, S. and Quigley, S (1994). Language Learning Practices with Deaf Children., (2nd Edition). Austin, Texas: Pro-ed.

Meadow, K. (1980). Deafness and Child Development. Berkeley: University of California Press.

Sebba, J, Ainscow, M. (1996) "International Developments in Inclusive Schooling: mapping the issues" Cambridge Journal of Education. Vol. 26, No. 1, 1996, pp. 5 - 18.

Susie Miles (2000) "Inclusion and Deafness" Manchester: EENET Issue 4: March 2000.

Moores, D (1987). Education the Deaf. Boston: Houghton Mifflin Co.

Northcott, W. (Ed.) (1973). The Hearing Impaired Child in the Regular Classroom: Preschool, Elementary and Secondary Years: A Guide for the Classroom Teacher/Administrator

Sacks, O. (1989) Seeing Voices. Berkeley: A Journey Into the World of the Deaf: University of California Press or N.Y.: Harper Perenial or London: Picador (Pan Books).

Solit, G., Bednarczyk, A. & Taylor, M. Access for All: Integrating Deaf, Hard of Hearing, and Hearing Preschoolers. Washington, D.C.: Gallaudet Press/Bookstore.

Villa, Rich (1999) "Inclusion is Happening Where?". TASH Newsletter October 1999 pp. 4 - 7

Wilson, A. (2000). "Considerations for Western Educators Working with Deaf Children in Developing Countries: Community Development in a Rural Brazilian Town. Paper presented at ICED, Sydney, Australia, July 12, 2000.

Nussbaum, D. There's a Hearing - Impaired Child in My Class.

(Cornoldi 98) In 1977 Italy adopted a national policy Law 517 with the addition of several other laws over the next two decades. on inclusion eliminate the suse of special schools and classes.

All taught in general education classes
No more than 1 student in class
No more than 20 students in all vs 25 normal
Support teacher for each student for up to 18 hours per week (insegnante di sostegno) who has some training but same salary.
Each support teacher has no more than 4 students in case load (1 : 2.2 current ( (Vianello 1996 in article)

20% served in regular classrooms in 1970 now 98.5% Vianelo 1996.


Academic goals poorly defined social objectives
Limited interaction with trained teachers in disability area

Accomplished goal survey 95 to 100% return rate excluding support teachers
Referred special children as those with learning problems

91.8% women and 8.2% men average class size 18.1 to 1 plus assistant
77.6% accepted the concept compared to 59.6% in US studies

Willingness to include 74.3% willing to teach students with leaning problems in schools vs 49.3 % in us 75.8% agreed that inclusion provided benefit to students with SEN.

53.6% agreed that it also benefited regular students

31.7 were uncertain of this.

18.6% agreed they had sufficient time for teaching students with learning difficulties.

27.7 in US surveys suggested they had enough time.

Enrollment 1 - 2.5% have certificates of disability excluding learning disabilities

22.3% of regular teachers said after 20 years experience with inclusion on 22.3% had sufficient skills to teach.
51.4% were uncertain 26.3% disagreed.. Compares to 29.2% in US studies.

10.7% agreed they had sufficient personnel support.. Same as in US 11% of 2,500 US teachers surveyed.

8.1% agreed they had sufficient instructional and classroom materials 66% said they did not have enough materials compared to 37.6% in US agreed they had sufficient materials.

Lopez, 1996

47 provinces including 3 autonomous cities Haiphong, Hanoi and HCMC

governed by local Peoples Committee appointed b y Peoples Counsel same as in districts and communes. Before French domination in 1858 VN had been strongly influenced by Chines hegemony and culture elite high morela curriculum. Chinese script until 1918. 1945 10% literacy rate. After reunification illiteracy fell sharply. Jan 1979 resolution education was emphasized. Preschool 0 - 3 kindergarten 3 - 6. less than 50% attend due to shortage of teachers. 6 - 11 years of age in basic Primary school. All children must pass exam at the end of each year and the primary school graduation exam in order to enter secondary school. Primary school free and compulsory but UPE is still far away. Primary teachers have 2 yr training beyond H.S. preschool 2 years beyond primary school.

Inclusive approach accepted by NIES in 1991 and 1992 Inclusive classrooms started in 7 provinces including Hanoi. Regular teachers received 3 weeks training. 1994 Administrators and principals and government officials also trained.

Rich Villa NIES estimates more than 1 million with Disabilities in Nam. First school for the Deaf 1866 started by the French. From 1975 to 1991 36 special schools existed.

1991 The Law for the Protection and Care for Children

Susie Miles EENT 2000 - "The importance of Sign Language as the medium of education among the deaf should be recognised and provision made to ensure that all deaf persons have access to education in their national Sign Language.

Deaf adults are so often overlooked as the most obvious human resource available for the education of deaf children. The over-professionalisation of special education has made it difficult for deaf people to obtain the necessary qualifications to become teachers. An ability to communicate fluently in S:L has not been considered a necessary qualification.

The challenge of the next 15 years is to work together with deaf adu7lts and existing special schools to promote Sign Language at family and community levels so that deaf childen can be included in EFA initiatives in their immediate community.

Seminar June summer 1999 in Manchester to discuss deafness and IE. "Inclusion and Deafness"

Judy Sebba and Mel Ainscow 1996.

"Inclusion describes the process by which a school attempts to respond to all pupils as individuals by reconsidering its curricular organization and provision. Through this process, the school builds its capacity to accept all pupils form the local community who wish to attend and, in so doing, reduces the need to exclude pupils." Page 9

EENT 1998 Radda Barnen "Towards Inclusion"

Vietnam 1991 supported by RB linked IE to CBR. Many students dropped out due to "lack of attention". They needed the added support and expertise of teacher trainers to prepare schools for inclusion. Lack of coordination between Health and education is not easy because of varying ideas and attitudes toward rehabilitation. Home leaning is promoted in the family setting. With a population of nearly 75 million the task is of introducing IE is clearly enormous, and coordination between CBR workers and teachers essential. Trinh Duc Duy NIES.




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