Abstract
In this presentation I will explain how the Child-to-Child approach is facilitating the inclusion of children with disabilities in mainstream schools in Karachi. This is happening in two ways:
1. As part of my work with the Institute for Educational Development I am involved in the Health Action Schools Pilot Project. Disability issues have been raised by teachers in 3 of the 5 pilot schools as part of a broader health education curriculum, using Child-to-Child. This has lead to the identification of minor disabilities in children already in school and improved attitudes towards persons with disabilities.
2. As a result of my previous experience in Community Based Rehabilitation (CBR) in Karachi, I am working informally with a small CBR centre, which requested my help in awareness raising about disability issues in the local schools (and community). They have started to use the Child-to-Child method with the children that attend the centre and the children will use the activities they develop (drama, songs, posters, etc.) to present their message to the children in the local school. They hope this will facilitate their admission into the school.
The Child-to-Child approach is proving to be very effective, as its ethos matches that of CBR and Inclusive Education closely, with its focus on levels of participation; Active Methods of teaching; intersectoral working; linking the centre/school with the community and giving greater responsibility and choice to children.
My name is Debbie Kramer-Roy and by background I am an Occupational Therapist, trained in the Netherlands and with experience in the UK and Pakistan.
Today I will tell you about my experiences with the Child-to-Child approach. I was first introduced to this approach during my Masters Degree in "Education and International Development: Health Promotion" last year and was then lucky enough to work with a project that puts the CtC approach in action. The first 6 months of my current employment with the AKU-IED, I worked as a team member of the Health Action Schools Pilot Project, headed by Dr. Tashmin Khamis. Although CtC aims to give general health education, topics around disability issues are an integral part of it. As one other team member, Farah Shivji, was a Special Needs Teacher, this facilitated the project and its pilot schools to give attention to disability issues. The topic on "Understanding Children Who Can Not See or Hear Well" was carried out by several of the pilot schools.
Although I was only part of the team for 6 months, I became convinced that CtC is not only a very effective approach to Health Education for children in mainstream schools, but I also felt it would be a very suitable approach for use with children with disabilities.
But before I go on to tell you about that, let me first introduce you to the CtC approach in general:
The Child-to-Child concept was launched in 1979, which was celebrated as the "Year of the Child". The founders are Hugh Hawes, a senior educationist and Dr. David Morley, a senior paediatrician, who both have extensive experience of working with children in developing countries. They introduced CtC as a new way of providing Health Education to school aged children.
The Child-to-Child concept was based on three fundamental assumptions, i.e.:
According to Bailey et al (1992) Child-to-Child is "not a rigid set of content and principles" and it has been implemented in many different ways. Activity Sheets and storybooks have been produced and are used world-wide (p7). The Activity Sheets contain information about key health issues and give ideas for action with the children. The Six Step approach is used to link home (the "living place") with school (the "learning place") and seeks to ensure that health knowledge and behaviour becomes internalised:
Some projects have adapted this approach and reduced the steps to 4. However they maintain the facilitation of children to taken an evaluative approach to their learning.
Active Methods are very important to the CtC approach and these include: Discussions, stories, pictures and the blackboard, demonstrations, surveys, visits and visitors, drama, poems and songs and games.
Another fundamental concept of the Child-to-Child approach is the concept of 'participation'. Hanbury (1995) identifies three levels of participation as follows:
The topic areas in the CtC activity books include Hygiene, Food, Safety, Preventing Illness, Looking after the Sick, Healthy Life Styles and Helping People with Disabilities. The ethos of believing in children's ability to teach others and of seeking the participation of ALL children is fundamental to CtC and helping children with disabilities to achieve well in school is an important theme.
So what caused me to start using the CtC approach with children with disabilities? One of the Community Based Rehabilitation Centres I knew from my previous time in Pakistan asked for help to review their activities and priorities. At this point it is important that we all share the same understanding of what CBR is supposed to be, as well as how this had worked in Bait-ul-Shafqat.
This definition clearly emphasises the need to work with community members with and without disabilities in order to provide a locally appropriate service, as well as a change in societal attitudes.
Over the past 15 years many CBR projects have been started in Pakistan and I have visited many of these projects. However the "community based" idea is often limited to the fact that a small group of community members takes it upon themselves to start providing treatment, and sometimes basic education, to children with disabilities in their own neighbourhood. But although the centre is placed in the community, staff does not tend to have the ability (and sometimes willingness) to involve the community in planning, implementation and evaluation - in other words the decision making process - of the project. Thus many of these centres are little institutions, placed - rather than based! - in a community.
Now back to Bait-ul-Shafqat. When I facilitated the staff to think about their current activities they clearly indicated frustration about the fact that it is difficult to really involve the community, beyond mothers bringing their children to the centre. They then thought through the things they would like to develop and when they ranked these according to degree of necessity, urgency and doability, "raising awareness in schools" came out as their priority. This was indeed a good place to start, as BuS had not been very successful so far to convince the local schools to grant admission to children with physical or learning disabilities.
I decided to offer them the option of using CtC as a method, as I could see several advantages in this. Most importantly learning about health issues through CtC would increase the children's confidence as they would e facilitated to think, take decisions, plan for action and take messages to others. Besides of course giving them and their families essential and sound information about health! Secondly the activities they would carry out could be taken into local schools and would show the schoolchildren that children with disabilities are confident and able to share information with them. Thirdly I expected that the teachers and principals of the schools would also realise the abilities and skills of children with disabilities and be helped to reduce their reluctance to admit these children in their schools.
So how were the CtC activities started in BuS. Let me make it clear from the start that due to my heavy workload at AKU-IED I have not been able to spend much time at BuS, especially during the week, so all the work with the children has been carried out by BuS staff independently. This, I feel, has been a distinct advantage in allowing the ownership of the activities clearly with the staff and the children. I initially held 2 training sessions with the staff in order to teach the basic principles and tools of CtC. Then it was time to decide which topics should be chosen first. Although the eventual aim would be to raise awareness about disabilities in the local schools, we felt that we should start with some simpler topics, so the staff and children could practice the process (6 Step Approach) before embarking on the more complex topic of attitudes towards disability. In addition the staff felt the children are really in urgent need of basic health knowledge and so this was not seen as a compromise in any way. In order to decide on priorities, again the staff ranked the topics, with Clean Hands, Clean Safe Water and Food coming out as the first priorities, before moving on to disability issues.
Although I supported the staff in the planning for the first topic, I was very pleased to see that I did not need to guide them on content and ideas, but only on the process of setting objectives and then chalking out the sequence of activities. In the early steps the children asked their family members when and how often they wash their hands and as they started to learn more they started to correct them. This caused some frustration, as the mothers did not all listen! However this is all part of the process and in the next topic the mothers were already starting to understand the aim of the Health Education activities better. In Step 4 the children invited their mothers and siblings to come and watch their role-play and the following pictures will show you how well they did this. (Talk through photos) As you can see this afternoon was very successful and the children were very pleased with their accomplishment.
During their next topic - Clean Safe Water - they decided to concentrate more on making posters, one example of which I can show you. However when they thought about what to do with these posters they decided to make another role play, in which a family complains they keep getting ill and then find a file of posters made by their cousin on the table and thus a discussion ensues about the importance of clean water.
Now the children and staff felt the time was ripe to go to the local schools, even though they had not reached the topics on disability issues. The staff contacted the schools, which were happy to allow a group of children and staff to take some time during assembly. The session on Clean Hands has already been presented in 4 local schools and the responses from both pupils and teachers have been very positive. In the local Salvation Army School the children were treated to soft drinks and biscuits by the Principal, who praised them highly for the effective way they taught other children about health.
This is an excellent start and the children look forward to carrying the work forward after the summer holidays. The hope is that by the time admission time for the next school year comes round (March) the attitude of the school administrations will have changed sufficiently to give children with disabilities a chance to study with their able-bodied peers.
The children and staff of BuS clearly see the double objectives of CtC for themselves and the local school children. Although initiated as a vehicle to gain access to school, they do certainly not see the Health Education as a less important or secondary objective. They understand the importance of good health practices in both general terms and in prevention of disability and long-term illness.
Let us finish on a thought about Inclusive Education. I am quite sure that at the end of this conference, I do not need to remind you of the child's right to mainstream education wherever possible. And I am sure you are all aware of the pedagogical and social befits for all involved as well!
I would therefore like to draw your attention to the supporting role both CtC and CBR can play in Inclusive Education.
I hope I have inspired you with this presentation and that you have been able to see the advantage of cooperation between different services or the combination of different approaches.
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