(The National Institute of Special Education, JAPAN)**
*e-mail:
kawasumi@nise.go.jp
**address:
5-1-1 Nobi, Yokosuka, 239-0841 Japan
Introduction
Since 1979, in Japan, homebound / hospital education, a form of educational provision by special schools (mainly schools for the intellectually disabled, the physically disabled and the health impaired) has been offered to students who are unable to commute to school for a long period (few months to some years) due to profound developmental disabilities, multiple disabilities and/or continued health problems. In this programme, teachers visit the residences of students such as personal homes, child welfare institutions, or medical institutions typically three times a week and provide guidance two hours per day.
The 1996 National Survey
In order to understand the current situation and issues involved in homebound / hospital education programme, Takei, Kawasumi, Hayasaka, and Takisaka (1997) conducted a nationwide survey of schools offering homebound / hospital education in 1996 (hereafter referred to as the "1996 National Survey") and reported the several findings. In this survey, we sent a questionnaire consisted of total 42 questions to all the special schools (431 schools) which offer homebound / hospital education programme and had a 88.1% response rate.
Based on results of the survey, 1,659 pupils (elementary and lower secondary school level) received the service of homebound education programme and 1,183 pupils hospital education programme. The numbers of teachers participating in these programme was 1,435. Though several issues were pointed out in this survey, four findings, which are available for discussion about strategy for inclusion of those pupils, in connection to homebound education programme are introduced in this poster presentation.
Findings 1.
Matters to be attached importance in the programme
We asked each school three matters that teachers attaches importance in the programme at home and obtained 782 answers from 312 schools (Table 1).
Firstly, most of the teachers focused much attention on pupils' health conditions of the day and their health management (1 in Table 1). Secondly, they attached importance on the cooperation between teachers (schools) and parents/caregivers or child welfare / medical institutions (2 and 9). About education itself for pupils several matters were pointed out (below 3 except for 9).
Table 1 Matters to be attached importance in the Programme
| Items | (Numbers of Answers) |
| 1) Grasping pupils' health conditions and their health management | (245) |
| 2)Cooperating between parents / caregivers and teachers | (173) |
| 3)Working with pupil in accordance with individual characteristics | (61) |
| 4)Contents and methods of guidance | (49) |
| 5)Promoting pupil's human-relation and communication behaviour | (39) |
| 6)Training of body movements / actions | (33) |
| 7)Devising of teaching materials and aids | (28) |
| 8)Expanding of pupil's experiences of daily life | (27) |
| 9)Cooperating between child welfare / medical institutions and teachers | (24) |
| 10)Promoting development of perception and cognition | (20) |
| 11)Making lessons an enjoyable experience | (15) |
| 12)Promoting pupil's initiative and active participation | (13) |
| 13)Establishing rhythm in pupil's daily living routines | (11) |
| 14)Positioning pupil in stable posture during learning activities that require adjustment | (8) |
| 15)Promoting interchange between pupil and people of the community | (8) |
2. Issues of educational conditions in the site of guidance
We asked each school two mattes : (1) issue of adjustment of educational conditions, and (2) the solution put to practice. We obtained 231 answers from 181 schools about the issues and 173 answers from 130 schools about practice. Table 2 shows the issues in the site of guidance on homebound education programme. It was found that teachers-in-charge have carried several problems on their back. Among them, the issue of utilizing public institutions including ordinary schools attracted our attention from the view point of strategy for inclusion.
Table 2 Issues of educational conditions in the site of guidance
| Items | (Numbers of Answers) |
| 1)To remove several environmental barriers in order to carry out learning activities outside home | (74) |
| 2)To get space of guidance in small housing | (45) |
| 3)To utilize public institutions including ordinary schools | (28) |
| 4)To adjust educational environment* in guidance room | (26) |
| 5)To be limited in teaching aids, materials and devices | (23) |
| 6)To make opportunity of learning or interchanging with other children | (18) |
| 7)To reduce parents' rejection against holding learning activities outside home | (13) |
| 8)Other | (4) |
3. Issues of Schooling
In homebound education programme schooling is carried out from a few times per week to sometimes per year according to students' health conditions, distance between special schools and homes etc. We asked each school three matters of issues concerning schooling in homebound education programme and obtained 520 answers from 241 schools. Table 3 shows issues of schooling. Though there are several problems in practice of schooling, two difficulties (1 and 2) attracted our attention from the view point of strategy for inclusion.
Table 3 Issues of schooling
| Items | Numbers of Answers |
| 1)Difficulty to secure transportation to attend special schools | (109) |
| 2)Difficulty to cope with children whose health conditions are unstable and/or who need special medical cares* | (97) |
| 3)Necessity of ongoing review on purpose, content and methods of schooling | (79) |
| 4)Getting cooperation from teachers in schools | (63) |
| 5)Necessity to take measures against the decrease f attendances | (37) |
| 6)Necessity to acquire a room for schooling and improve equipments | (30) |
| 7)Interchange with pupils in schools | (26) |
| 8)Parents' understanding about the signification of schooling | (23) |
| 9)Difficulties of attendance due to long distance, family circumstances etc. | (21) |
| 10)Use of parents' waiting hours who accompany the child to and from school | (16) |
| 11)Other | (19) |
*e.g.; tube feeding, suction of sputum (phlegm), urethral catheterization, hygiene management of body area related to tracheostomy (tracheotomic cannula), insertion of airway, oxygen therapy (oxygen inhalation), inhalation of medicine (use and management of nebulizer), etc.
4. Topics of Discussion with Parents
We asked each school to choose five most discussed topics with parents/caregivers from 15 selection items and obtained answers from 328 schools. Table 4 shows 15 topics arranged in order of numbers of selections. Two items being higher in rank are involved with pupils' health. Most of the teachers seem to play the role as a partner of or an adviser to parents.
Table 4 Topics of Discussion with Parents
| Items | Numbers of Selections |
| 1)Special care for the maintenance of child's health | (320) |
| 2)Information of medical institutions | (162) |
| 3)Ways of nurturing at home | (162) |
| 4)Child's growth or development | (137) |
| 5)Guidance for post-graduation life | (123) |
| 6)Impairments and disabilities of the child | (122) |
| 7)Contents of education | (122) |
| 8)Siblings, other family members, and relatives | (115) |
| 9)Utilization of welfare services | (106) |
| 10)Schooling | (93) |
| 11)Therapeutic activities outside schools* | (70) |
| 12)Changing from homebound education to in-school education | (59) |
| 13)Relationship with communities | (27) |
| 14)School trip | (17) |
| 15)Other | (10) |
There are few physiotherapists in special schools, and most of therapists (PT, OT, ST) are in hospitals or welfare centres for disabled.
Discussion
1. Signification of the homebound education programme
The homebound/hospital education services are provision to guarantee children the right to receive proper education based on the policy for "School Enrollment of All" or "Education for All". Therefore, teachers-in-charge of homebound education programme visit each home and guide children who have difficulty commuting school due to unstable health conditions and/or need continued medical cares. Teachers also play an important role as a partner for parents who are often isolated from community and necessary information.
2. Strategy for inclusion
In the 1996 National Survey it was found that most of the parents utilized homebound education service positively and some of parents and teachers have had the hope that the children may be able to commute to schools?special schools or ordinary schools). It seems that there are five types or targets of inclusion to realize as follows; types 1) and 3) are already put to practically or made efforts in many schools throughout the country, 2) is tried in big cities where transportation service and medical care systems are advanced, 4) is not tried in any region, and 5) is tried in a city within a metropolitan.
1) To assure pupil's schooling and increase the opportunity
Necessary conditions for realization are (1) support for transportation to school, (2) establishment of cooperation system among teachers within school and (3) adjustment of system in medical care support.
2) To support pupil for a regular commutation to special school
Necessary conditions are (1) maintaining relatively stable health conditions of pupil and (2) establishment of system in medical care support.
3) To further utilize resources in public institutions during homebound education service and to expand to the use of resources in ordinary schools
Necessary conditions are (1) understanding and support of ordinary school within the school district, (2) removal and reduction of several environmental barriers.
4) To provide schooling at ordinary school
Necessary conditions are (1) understanding and support of ordinary school of child's school district, (2) removal and reduction of several environmental barriers and (3) establishment of system in medical care support.
5) To support pupil for a regular commutation to ordinary school
Necessary conditions are (1) maintaining relatively stable health conditions of pupil, (2) support by special schools and education centres, (3) establishment of system in medical care support, and (4) in-service training for teachers of ordinary schools.
 |
 |