Meeting 2, Belgium, 2009 February

Transcription

Cooperating with parents in early intervention
Reference number: 2008-GRU-LP-PA-161
Grundtvig meeting in Belgium
23/02/2009 to 27/02/2009
De Kangoeroe, home-based early childhood intervention service
Kasterstraat 81 9230 Wetteren Belgium
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Content
1. Participants
2. Program of the meeting
3. Belgium, an introduction
3.1. Geography
3.2. General information
3.3. A political structure on three levels
3.4. Competencies of the various bodies
3.5. Consequences for the families with children with disabilities
3.6. Federal state policy
3.6.1. Social security
3.6.2. Social advantages
3.7. Policy of the communities for persons with disability
3.7.1. The Educational system
3.7.2. Special needs in Belgian school system
3.7.3. Policy to people with disability
3.7.3.1. The VAPH
4. Early childhood intervention in Belgium
4.1. The start
4.2. Mission
4.3. Planning
4.4. Aged ranged
4.5. Admission to the program
4.6. Working models
4.7. Grant
4.8. Financial contribution for the parents
4.9. Control and evaluation
5. The Kangoeroe, home based early childhood intervention
5.1. Introduction
5.2. Mission
5.3. Vision
5.4. Global aims
5.5. Values
5.6. Target group
5.7. Population
5.8. Team
5.9. Announcement
5.10. Intake
5.11. Guidance
6. Home visits with the Kangoeroe
6.1. Home visits
6.2. Discussion
6.3. Summary
2
7. Meeting with the parents
8. Evaluation
3
1 Participants
Partner 1:
SHFI – Sozial- und Heilpädagogisches Förderungsinstitut Steiermark
Institute for special educational and social promotion Austria
Anna Kirchschlager [email protected]
Sabine Obiditsch
[email protected]
Partner 2
Sorlandet support centre for special needs education Norway
Monica Ingemarsson [email protected]
Kirsten Ruud
[email protected]
Partner 3
De Kangoeroe vzw Belgium
Dirk Mombaerts
Carla Schacht
Els Van Hoorde
Ilse Laethem
Chris Mouton
Nadine Bogaert
Sabine Mynsberghe
Els Bourgoignie
Emily Vlerick
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
The parents of
Tibo, Jorik, Luna, Matteo, Ward, Fé, Jasper, zcan, Klevia, Kyara, Quentin, Ciana, Jitske,
Mathias, Wouter, Luna, Bram
Partner 4 ( non official )
Cooperativa de Educação e Reabilitação de Cidadãos Inadaptados de Montemor-oNovo Portugal
Maria Luisa Trindade
Ana Cristina Saloio
Otilia Marques
[email protected]
[email protected]
[email protected]
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2 Program of the meeting
Monday 23/2/2009
Arrival and transfer to hotel in Ghent
20 u : meeting at the restaurant in GHENT
Thuesday 24/02/2009
8.30 transfer to Kangoeroe Wetteren
09.00 – 12.30: Early intervention in Belgium
12.30 – 13.00: lunch
13.00 – 16.30: home visit
17.00 back to hotel: evening free
Wednesday 25/02/2009
9.00 home visit
12.00: preparing lunch
13.00 -14.00: The early intervention model of the Kangoeroe
14.00 – 16.00: weakness and strengthens ofm the Kangoeroe system
16.00 ot 17.00: walk into the Kalkse Meersen
18.30: preparing dinner for parents and professionals
20.00 meeting dinner with parents
Thursday 26/02/2009
9.00 : Visit to residential centre for special care for small children
12.00 – 13.00 : Lunch at the Kangoeroe
13.30 to 15.00 : evaluation, expectations next visit
17.00: preparing visit to Austria, planning data Grundtvig 2009 and 2010
Friday 27/02/2009
Travelling home
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3 Belgium, an introduction
Belgium is like European in small with language communities, regions and districts. For a
foreigner our federal structure is rather complicated.
3.1. Geography
Covering a surface area of 32,545 km² and with 10,239,085 inhabitants, Belgium is one of the most
densely populated countries in the world with an average of 314 inhabitants per km². It is the
geographical centre of the European Union. Its federal capital is Brussels.
In the north, Belgium borders the North Sea and the Netherlands; to the east it shares a border with
the Federal Republic of Germany and the Grand Duchy of Luxembourg; and to the south and west it
borders France. The country enjoys an oceanic temperate climate characterized by moderate
temperatures (an average of 11.2°C), dominant winds blowing from the west, generally thick cloud
cover (an annual average of 1,392 hours of sunshine) and frequent rain (average rainfall is 852 mm).
The country is divided into three geographical zones: low Belgium in the north (with an altitude of
below 100 m), middle Belgium (between 100 and 200 m in altitude) and high Belgium (between 200
and more than 500 m in altitude). At 694 m, the Signal de Botrange is Belgium's highest point.
The proximity of the North Sea and the Ardennes explains Belgium's particularly favourable
geographical location. Major highways cross the country, and the motorway density is 51 km for
every 1,000 km², a total length of 1,631 km, nearly double the extent of the German network.
3.2. General information
There are two main language communities in Belgium: the Dutch-speaking Flemings in the
north, and the French-speaking Walloons in the south. Brussels is officially bilingual,
although most of its inhabitants are French-speaking. In the far eastern part of the country
there is a small German-speaking community. The Dutch-, French- and German-speakers
form three autonomous Communities, each with their own linguistic and cultural policies.
Vote
Voting is compulsory in Belgium.
Education
Schooling is compulsory for 12 years, between ages 6 and 18. On average, however, young
people go on to study until they are 23, making Belgium second only to the United Kingdom
in this respect. More and more young Belgians are earning university degrees each year.
Religion
The principle of religious freedom is written into the Belgian Constitution. Most Belgians are
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Catholics, but other religions such as Islam, Protestantism and Judaism are also widely
practised in Belgium.
Social security
As in other EU countries, Belgian families are getter smaller (the current birth rate is just
1.56). The country is also facing the problem of an ageing population: already 15% of the
people are over 65. However, the society is founded on the principle of solidarity and a vast
social security system is now in place: everyone is entitled to family benefit, an old-age
pension, health insurance, unemployment benefit and paid leave.
Life expectancy
Life expectancy is 75 for men and 81 for women.
Work
Belgians are active in the sectors of agriculture, industry, services (banks, hotels, childcare,
etc.), IT and research. Many women work and childcare is strictly monitored and regulated.
Media
Virtually the whole country is wired for cable TV and radio. The various cable companies
offer a total of 41 channels. Each household can receive 30 cable channels. In addition to
having public French- and Dutch-speaking channels, Belgium has three commercial stations
(two in Dutch and one in French), and a number of local stations. The radio market is also
divided up into public, private and local stations. The written press aims to reflect all popular
views in Belgium. The foreign press also has a large circulation, mostly in Brussels.
Typically Belgian…
Run through with language issues and widely varying socio-economic and identity concerns,
Belgium has adopted a peaceful method for settling the disputes that sometimes arise out of
this diversity: the well-known "Belgian compromise."
Belgians are also known for building their own houses (the local expression is "born with a
brick in the belly"). They invest heavily in their homes and the renovation market has been
booming for several years now.
3.3 A political structure on three levels
By gaining independence in 1830, Belgium became a unitary state where the decisionmaking power derives from a national parliament and a national government. Four state
reforms (carried out in 1970, 1980, 1988-1989 and 1993) have transformed Belgium into
what it is today: a country that reconciles regional and cultural identities in a single federal
structure.
The unitary Belgium of 1830 gave birth to a current, more complex structure on three levels:
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the upper level comprises the federal state, the Communities and the Regions; the middle
level is occupied by the Provinces; and the lower level is that of the Communes.
Accordingly, Belgium is made up of three Communities (the Flemish Community, the French
Community and the German-speaking Community), three Regions (the Flemish Region, the
Brussels-Capital Region and the Walloon Region), 10 Provinces (Antwerp, Flemish Brabant,
Walloon Brabant, West Flanders, East Flanders, Hainaut, Liège, Limburg, Luxembourg,
Namur) and 589 Communes.
At present, decision-making powers are no longer exclusively the competency of the federal
government and federal parliament. The country is run by various bodies which discharge
their allotted duties autonomously.
Communities
Regions
In orange you see the Dutch speaking Flemish community with approximately 6 million of habitants
In red you see the French speaking community with approximately 3,3 million of habitants
In green you see the German speaking community with approximately 75 000 of habitants
Yellow-red is Brussels city with approximately 1 million habitants with as well French as Dutch as an official language. The
Dutch speaking habitants from Brussels belong politically to the Flemish community , the French speaking habitants belong to
the French speaking community.
3.4. Competencies of the various bodies
The federal state remains responsible for managing everything that affects the interest of all
Belgians, independently of any linguistic, cultural or territorial considerations: for instance,
foreign affairs, national defence, justice, finance, social security and a major share of public
health and domestic affairs. It is also the federal state that assumes all the responsibilities
that Belgium and its federated entities have vis-à-vis the European Union and NATO.
The Communities are competent to deal with matters relating to the people composing
them, such as language, culture and education.
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The Regions are competent to deal with territorial matters such as town planning, the
environment and employment.
Instead of being under the supervision of the central state like before, the Provinces act
within the framework of competencies at the federal, Community or Regional level, being
primarily also under the tutelage of these various authorities.
The Communes are the seats of power that are closest to our citizens. Like the Provinces,
they are under the tutelage of the various other authorities.
3.5. Consequences for the families with children with disabilities
Our federal structure made that families are supported on several levels
National level
Social security ( supplement1 )
National health
Allowances for people with disabilities.
Family allowances are paid for every child up to the age of 25 years
Decrease of fiscal taxes
Social rates for telephone, gas and electricity
Applications for parking card
Community
Ministry of Education
Ministry for Welfare, Public Health and Family ( this Ministry covers the Agency for disabled
persons )
Provinces
Coordinating the demands people with disabilities
Coordinating the regional cooperation between the different services for people with
disability
Communes
Private parking place for the family car in front of the house
Some communes gives some small grants
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3.6. Federal state policy for persons with disability
3.6.1.Social security ( see also supplement 1 )
Medical treatment
-
The reimbursement of medication ,medical care and therapy. For people with an
impairment the federal state reimburse a higher degree of medical costs. Therapy for
children in rehabilitation centers are for example for free. For children with a special
pathology the personal amount that must be paid to a private therapist is much lower
than regularly.
-
Consultation to specialized medical reference l centers for different impairments (
Cerebral Palsy, Neuromuscular diseases, Spine Bifida,…)
Allowances
-
Family allowances are paid for every child up to the age of 25 years. The amount of
the allowance varies according to child‟s age
-
Increased family allowances are paid for the disabled children up to the age of 21
years. According to:
-
The degree of the deficiency
The need for help and rehabilitation
The parents commitment
The amount varies from 75 euro to 490 euro per month
-
-
Allowances for replacing remunerations are paid to disabled people who are not able
to work.
The amount varies from 5.700 EUR to 11.400 EUR per year.
Integration allowances are paid to disabled people who are not able to work and who
- due to their reduced autonomy - have to bear additional expenses to assure their
integration into society.
The amount varies from 1.100 EUR to 9.500 EUR per year.
Both allowances can be combined
All people with disabilities in sheltered work places work on the basis of an ordinary
contract of employment and are being paid a guaranteed monthly minimum income.
For the moment, the amount is 1.440 EUR per month for a full-time job.
3.6.2. Social advantages
-
Moreover, there are social advantages for disabled people
- fiscal advantages
- advantages in the field of mobility
- advantages in the field of communication
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3.7. Policy of the communities for persons with disability
At the beginning of 1985: transfer of competences related to persons (i.e. education, culture,
health and social affairs) from the national state to the 3 language regions
So this regions became responsible for the education policy, included special education and
the policy to people with a disability.
The Office for people with disabilities
in the Belgian context
Federal Public Service –
Social Security
Flemish Agency for
persons with
Disabilities
Walloon Agency for
the Integration of
People with
Disabilities
Brussels FrenchSpeaking Service for
People with
Disabilities
Office of the Germanspeaking Community
of Belgium for People
with Disabilities
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3.7.1. Educational system
In the Belgian system, the communities decides about personal matters, like education.
Therefore, the Flemish Community is responsible for the organization of education in the
Dutch speaking community.
General principles of our educational system
- Compulsory education for all children from six to eighteen
- Control of education costs until the end of compulsory education
- Freedom of education
- Equal opportunities in education
- Educational networks
- Financial support to education
- Autonomy
Different organizational structures of education
In Flanders there are several organizational structures who organize education. All these
structures have their own policy, their own responsible people, their own arrangements of
subsidies. This difficult structure is a heritage of earlier history. Both type of schools gives a
similar educational program with similar outcome.
 “private subsidies schools “ : private subsidies schools divided in confessional and
non confessional schools
o The private subsidies confessional schools are the majority . They are
especially catholic schools and in the special education they represent
approximately 90 % of the special school population. Pupils at this kind of
schools get religion as a subject.
o The private subsidies non confessional schools are a minority and they
consists of Freinet schools and Waldorf schools ( Camphill in special
education).
 “public schools” : this schools are managed immediately by the local community or
by the Flemish community. Pupils of all kind of religions come to this schools. In this
schools there is an offer of different types of religion.
Parents are free to chose between private subsidies schools or public schools.
Different levels of education
There are three levels of education : elementary educationlevel, secondary education level
and higher education level. On the level of elementary en secondary education, there are
also special schools.
On the first two levels, school is organized from Monday until Friday from around 8h30 until
16h00. On Wednesday, it is only half a day.
1. Elementary education
This level contents on the one side the preschool level and on the other side the primaryschool level.
The preschool level is for children from 2,5 untill 6 years old.
The primary-school level is for children from 6 untill 12 years old.
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On preschool level, the offer of education is free. Parents can choose if they want to send
their child to school. Most of the Belgian parents do it (95% of the children of five years are
going to school). The teachers are specifically educated to teach these young children.
The activities in the class are relied on the development goals, formulated by the
government.
Primary-school level are 6 successive years. At the end of these 6 years, children get a
certificate of primary school.
The government formulated learning goals, which should be gained by every child at the end
of that schoolyear.
At this level, there is no “school-duty”, but a “study-duty”. That means that parents are not
obliged to send their children to a school, but they do have the duty to make sure that the
child gains the learning goals at the year of 12.
2. Secondary education
Secondary education is aimed at young people aged 12 to 18. Since 1989 the secondary
education has been organized in a uniform system.
In the first stage, all the pupils have a similar program.
From the second stage, we distinguish four different education forms:
General secondary education
Emphasis on broad general education and preparation on tertiary education
Technical secondary education
Emphasis on general and technical subjects. After this kind of education, pupils can exercise
a profession or pass on to tertiary education.
Secondary arts education
Combination of broad general education with active arts practice. After this kind of
education, pupils can exercise a profession or pass on to tertiary education.
Vocational secondary education
Practice-oriented education. Pupils learn a specific occupation in addition to receiving
general education.
3. Higher education (tertiary education)
There are:
Bachelor courses
Professional bachelor courses
Academic bachelor courses
Master courses
Further training courses
Postgraduates and updating and in-service training courses
Doctoral program
3.7.2. Special Needs in Belgium School System
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Belgium's approach to special needs education is one of inclusion and equality. There is a
strong commitment to giving every child the right to an education which maximizes their
potential.
Because Belgium has passed responsibility for implementing government policy to the
individual language communities and their respective Ministries of Education, the exact
approach used depends on where the child is resident.
For detailed information on all aspects of educational policy, consult Eurydice
(http://eacea.ec.europa.eu/portal/page/portal/Eurydice), the EU education database.
The information below aims to give an overview of the methods employed and details of
financial and other support provided for families of children with special needs.
Special Needs Education
Full-time education is compulsory from six to sixteen years, part-time education is
compulsory until the year that the child reaches the age of eighteen. Inclusion of a child with
special needs in mainstream education is not always possible and in extreme cases a child
may be given exemption from compulsory schooling. Alternatively, perhaps due to illness or
repeated periods of hospitalization, a child may be taught at home. However, in many cases
education is provided by a specialist school.
Special provisions within mainstream schools
Some children with disabilities are going to regular schools. They can receive support from
schools of special education:
- G.On-guidance (= integrated education): This is organized for children from type
3,4,6 and 7 and 8. In fact, this is a collaboration between normal schools and
specials schools. The special school gives assistance in the normal school (by
sending a teacher to that school). In turn, the special school receive additional
teaching periods or/and additional hours. The pupil needs an attest on which the
degree of disability is defined.
Type
3
4
6/7
8
-
-
Moderate
Severe
2 hours, 2 years
2 hours, 2 years
2 hours, every year
4 hours, every year
(Primary, secondary and higher
education) 2 hours, 1 year
(primary education only) 1or 2
hours, 1 year
I.On : inclusive education. This project wants to support the integration of pupils with
a moderate of severe mental disability into normal education. Only in elementary and
secondary level. The pupil needs a type 2 certification.
GOK : integrated equal educational opportunities policy
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The Equal Educational Opportunities Decree (2002) wants to counter exclusion, social
segregation and discrimination and therefore specifically focuses on children from
disadvantaged backgrounds.
Specialist Schools
Aside of “mainstream education”, Flanders also offers “special education” at elementary and
secondary level. This special education is provided by specialist schools.
Specialist schools are classified in eight categories. Some schools will combine more than
one category. There are schools especially for the physically handicapped as well as
schools for the visually impaired. Other schools cater for those with learning or behavioural
difficulties. In some cases they operate as specialist units attached to mainstream schools.
Most of the special needs categories are catered for with schools at pre-primary, primary
and secondary level. Special education is available to children from two and a half to twentyone years of age.
There are 8 types of special education on the basis of the nature and degree of the disability.
This classification is not always easy. All of us know some children with multiple handicaps.
When we have to find a good special school for one of these children, we look for the
domain on which the child has most problems at that moment. This means that sometimes
children do have to switch from school during their career.
Some schools are specialized in one type, other schools combine different types.
Although there‟s a movement of inclusion going on, we do have a lot of children in special
schools. 1
Preschool ( 3-6 y.)
Primary school ( 6 –
12y..)
Secondary school (
12-18 y.)
2006-2007
20052006
2004 2005
2003 2004
2002 2003
2001 2002
2000 2001
1.907
1.821
1.791
1.720
1.726
1.686
1.701
26.794
26.753
26.768
26.952
26.901
26.794
26.212
18.189
17.801
17.393
16.792
16.402
16.084
15.763
General objectives
“It is education which, on the basis of a pedagogical project, provides an appropriate
education, upbringing, care and therapy for pupils whose overall personal development
cannot be or is not sufficiently catered for by mainstream education, be it on a temporary or
permanent basis”. (decree of 25 feb 2997)
When a child gets a certification for a specific type of school, parents can go and visit
different schools of that type. In theory, they have the freedom of choosing that school they
most like for their child.
In reality, they still have that freedom of choice but there is not a big choice. Special schools
1
For more numeral information : http://aps.vlaanderen.be/statistiek/cijfers/stat_cijfers_onderwijs.htm
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are not evenly spread among the country. This means that children often have to spend a lot
time on the bus. A difficult subject for parents…
Just like mainstream education, special education is also organized by the different
organizational structures.
Organization
The 8 types of special schools:
- Type 1 : children with a mild mental (=intellectual) disability
- Type 2 : children with a moderate or severe mental disability
- Type 3 : children with severe emotional and/or behavioral problems
- Type 4 : children with a physical disability
- Type 5 : children admitted to hospitals or residing in preventoriums on medical
grounds
- Type 6 : children with visual disability
- Type 7 : children with aural disability
- Type 8 : children with severe learning disabilities
Type 1 and 8 are NOT organized on pre-school level (so not for children younger than 6)
At the secondary level, 4 education programs (OV) are organized. Each of them prepare the
students to a different level of further “working life”:
- OV 1 : for students who are unable to live an independent life
- OV 2 : for students who can manage by themselves to a certain extent and they get
training to prepare themselves for work in a sheltered work and living environment.
- OV 3 : for students capable of following vocational education which prepares them for
a job in a normal working environment
- OV 4 : for students with sufficient intellectual capacities to attend mainstream
edcution but for whom special teaching methods and arrangements are used,
adapted to their specific disability.
French: l'enseignement specialisé
Dutch: buitengewoon onderwijs
German: Vorschul
Specialist schools are classified in eight categories. Some schools will combine more than
one category. There are schools especially for the physically handicapped as well as
schools for the visually impaired. Other schools cater for those with learning or behavioural
difficulties. In some cases they operate as specialist units attached to mainstream schools.
Most of the special needs categories are catered for with schools at pre-primary, primary
and secondary level. Special education is available to children from two and a half to twentyone years of age.
Be aware that in some areas of the country there are few special schools and children may
be offered places in a school outside their own community.
Enrolment requirements
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Enrolment in a special school is at the request of the family. Before a place is given there is
a multi-disciplinary examination. In the French and German speaking communities this is
handled by the Psychological-Medical-Social-Centre (centre psycho-medico-social, PMS). A
similar body, the Centre for Guidance (Centrum voor Leerlingenbegeleiding, VCLB) operates
in the Dutch community. The findings of the examination committee will determine the school
judged to be most appropriate.
Enrolment into a special school can take place at any point in the school year. Parents with
children likely to require specialist education should provide as much documentary evidence
regarding their child's condition as possible. In some areas of the country children with
learning difficulties or behavioral problems (as opposed to physical handicaps) are required
to spend an initial period in a mainstream school before being considered for a place at a
special school.
Educational approach
The school day and school term in special schools follows that of mainstream schools very
closely.
Within the French speaking community, education is organized not by age and cycles as in
mainstream schools, but by four levels of maturity/competence. A child moves from one level
to another when certain skills have been acquired and this may happen at any point in the
academic year.
Within the Dutch and German community the approach is much closer to the cycles adopted
by mainstream schools.
In all cases children are taught by qualified teaching staff at all stages and have
personalised study plans. Where required, teaching staff are supported by medical
professionals, social workers and psychologists. Children may follow an adapted programme
of secondary education if they are capable of doing so, culminating in the same diplomas as
pupils in mainstream schools. The aim is always to help them achieve their potential at
school and in the workplace. Pupils are observed and evaluated continuously and children
may return to mainstream education at any time if this is thought to be in their best interests.
Parents may request or oppose such a move.
In certain cases children may divide their time between a special school and a normal
school. Funding is provided to allow specialist staff to accompany them to the mainstream
school if necessary.
School transport
Special schools by their very nature may require some additional travelling. Transport to the
nearest appropriate school is almost always provided free of charge either by school bus (in
which case there is always someone to accompany the child) or by private vehicle, specially
adapted if necessary.
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Special Needs Education in Mainstream Schools
Many children with special needs can be catered for in mainstream schools. Some schools
have a permanent member of staff who is a special needs expert. Schools can apply for
funding to pay for additional staff, special equipment or teaching materials which will allow
them to accommodate children with special needs. This may also extend to providing
additional help for children who do not speak the main teaching language.
For children with learning difficulties such as dyslexia or Attention Deficit Hyperactivity
Disorder (ADHD), the usual approach is for them to be educated in a mainstream school
with additional support. As each school is different, there are various organisations that may
be able to recommend schools.
All schools remain in close contact with parents via a system of notes, assessments and
parent/teacher consultations. Children with special needs are assessed even more closely.
Parents have the right to ask for reviews or assessments if they have concerns for their
child. The class teacher will normally undertake initial assessments but more detailed tests
to assess speech and language development may be necessary. These are again the
responsibility of the VCLB or PMS centres.
Parents are normally asked to take their child to their own doctor for a medical check-up as
well and this includes hearing and sight tests.
Just as children may move back into mainstream education from a specialist school, other
children may move out of ordinary school and into a specialist establishment if this is thought
to be necessary.
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3.7.3. Policy to people with disability
Each region as his own agency for persons with disabilities with his own objectives and
rules.
The Office for people with disabilities
in the Belgian context
Federal Public Service –
Social Security
Flemish Agency for
persons with
Disabilities
Walloon Agency for
the Integration of
People with
Disabilities
Brussels FrenchSpeaking Service for
People with
Disabilities
Office of the Germanspeaking Community
of Belgium for People
with Disabilities
The Flemish agency for Persons with disability
The Wallon agency for the integration of people with disability
Brussels French-Speaking Service for People with disabilities
Office of the German-speaking Community of Belgium for People with Disabilities
We focus in this report shortly on the Flemish agency for persons with disabilities VAPH
because the Kangoeroe vzw is depending of the grants and the rules of this agency. Later in
the report we will focus on the different legislations in each agency on the matter early
intervention
3.7.3.1. The VAPH ( Vlaams Agentschap voor Personen met een Handicap) ( Flemisch
Agency for Persons with disability)
General introduction to the VAPH
The field of welfare is very much scattered in Belgium. People with disabilities can ask for
support at different organisations and institutions. Here follows a short overview of the
different possibilities.
Federal government agencies:
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Compensations (compensation for integration and wage substitutes)
Increased child allowance
Health care, revalidation and medical costs
Social rates for telephone, gas and electricity
Applications for parking card
The Flemish and Walloon communities are qualified for the individual matters. Social
welfare belongs to this category. The welfare policy of the Flemish community is spread out
over different fields; social services, poverty alleviation, family assistance, geriatric help, …
Each organisation targets one specific group. Next follows a description of the role of the
VAPH on the field of the policy for disabled people.
The VAPH
The VAPH is a public body with legal personality within the remit of the Flemish government.
It has its own Council thanks to which it has a certain degree of independence. Its function
is to tune demand and supply to one another. The VAPH advises the minister in his policy
by listening to the demands of the target group while taking into consideration new
scientifically insights. As a governmental institution, the VAPH doesn‟t have its own
services. It recognises, subsidises and controls private institutions.
Target group
The decree of 27 June 1990 defines "disability" as follows:
"Any major long-term restriction of a person's ability to integrate into society as a result of an
impairment of his/her mental, psychological, physical or sensory (auditory and visual)
capabilities".
Incapacity and disorder
It has already been stated that assessments would no longer be based on purely medical
grounds. Now attention is being paid to the total functioning of a person in society. In line
with current thinking, a disability is regarded as the social consequence of disorders which
give rise to incapacities. A disorder is seen as the absence of, or a defect in, a physical or
mental function or structure. Incapacity can be defined as any restriction or absence of the
ability to carry out a normal human activity (e.g. walking, seeing) as the result of a disorder.
The greater the inability to carry out a specific activity, the more integration difficulties are
likely to occur.
Long-term and severe
The VAPH is not meant for people who, for example, have temporary physical difficulties
after surgery.. Neither does the target group include young people who have learning
difficulties which can be fully met by special education. The incapacity must be of a longterm kind. In addition, the long-term incapacity must have a certain degree of severity in
order to become a disability within the meaning of the decree.
Impairment of mental, psychological, physical or sensory capabilities
20
Incapacities must therefore be the result of a disorder in the person him/herself. The
opportunities for people to integrate into society can also be impeded by a poor educational
level. The particular problems of these people cannot be dealt with by the VAPH. They can,
if necessary, turn to general welfare facilities or other specialist agencies.
From the definition we can deduce an important feature of the VAPH: its multidisciplinary
approach. This means that not only is paid attention to the person, but also to his entire
environment. A multidisciplinary team prepares a file that considers the social, psychological
as well as mental aspects. An evaluation commission discusses all the different angels of
the demand.
Beneficiaries
As a general rule, applicants must actually reside in Belgium. At the moment of the request
they have to be able to prove an uninterrupted stay of 5 years or an interrupted stay of 10
years in Belgium. The legislation covering the VAPH furthermore only applies to disabled
persons under the age of 65 at the time of their application for registration. This is the first
restriction. Persons already registered before reaching that age can continue to benefit from
the Fund. This is only for handicaps with which the person was confronted before his 65th
birthday.)
Tasks
These tasks are translated into various types of services and related development of
facilities. The services can generally be divided into four basic categories:
Individual material assistance
Training and employment
Care, treatment and guidance in suitable facilities or by agencies, which enable people
to continue to stay in familiar surroundings.
PAB
IMB
The VAPH can offer under certain conditions compensation in the costs of appliances and
adaptations. Overall objectives are to minimise the restrictions of a disabled person and to
maximise their integration.
Some examples:
Appliances for daily life (elevator, adjusted chair,…)
Adjustments to the house
Devices that increase mobility
Communication aids
Assistance by an interpreter for the deaf
Incontinence material
All appliances and adaptations, for which people with disabilities can receive a financial
contribution, are grouped on a list. This list has been classified in function fields: bottom
limbs, upper limbs, trunk, pelvis and spinal column, the sense of hearing, visibility, speech
and incontinence. The financial contribution the VAPH refunds is mentioned for each
21
appliance. This amount is calculated by means of the average cost of the appliances. The
Assistance Commission discusses appliances that are not mentioned on the list or very
expensive materials. When it is shown that the appliance is functional and that it will be
used frequently, then the person with a handicap can get a financial contribution.
Function of the KOC:
Information spread on appliances
Advice about appliances
Creating a database: Vlibank. This database contains information on more than 12000
appliances
Training and employment
The VAPH offers:
Financial help for diverse training programmes.
Individual support for employers with a handicap. Under special conditions, the VAPH
can reimburse the employee with a disability certain expenses for working clothes,
working tools or relocation to and from the workplace. Also support by a personal
assistance or interpreter for the deaf at the workplace is possible.
Subsidies for employers who hire disabled people. The VAPH supports the employment
of people with disabilities by allocating financial contributions to the employers. This
means subsidies for the wage of the employee, subsidies for involving people with a
handicap in the production process and the reimbursement of the extra charges spent for
the adjustment of the workplace to the person with a handicap.
Access to employment in sheltered workshops. Sheltered workplaces offer people with
disabilities the opportunity to work in an environment which is suitable for them and in
which they can develop themselves. People with disabilities can practise an adapted
profession in these sheltered workplaces.
For the person who wants to work but who needs some assistance, there is supported
employment.
Care
The care contains multitude of guiding and support possibilities. There are centres for adults
and for minors. There is full-time (7 days a week) and part-time (1 to 4 days a week)
guidance. There is also temporary guidance to for support in more difficult periods. The
Flemish Agency pays those institutions directly for each assistant or for the duration of their
stay.
The care sector is divided in 2 parts:
Community- based services:
to help people with disabilities to live in an independent way, they can use different types of
assistance. Some people with disabilities live in an independent way.
E.g. An „independent living service‟ renders permanent stand-by assistance to persons with
a severe motorial disability, occupying an adapted equipped house. This assistance is called
22
ADL-assistance, which stands for Activities Daily Life, consisting of aid towards daily
activities like washing, dressing, toilet, full dress, pick a book from the shelve etc.
The combination of adapted houses and service rendering is called an ADL-cluster.
An ADL-cluster could be defined as follows: a whole of 12 to 15 ADL-houses located
randomly (max. 2 ADL-houses next to each other) in a radius of about one hundred meter,
connected, by means of intercommunication with the base office (ADL-base), from where
the assistance is organised.
As the houses need to be reserved for the service users, ADL-houses are in principle rented
houses.
In a usual ADL-cluster there are houses with different surfaces, supplying accommodation
for both single persons and bigger and smaller families.
In any ADL-house there is the necessary obstacle-free space, enabling wheel chair users
easy manoeuvring; besides a number of facilities (like kitchen and bath room) can be
adjusted or adapted, in line with the specific disability of the respective successive tenants.
Specialised and long lasting, as well as out-of-doors activities, do not belong to the ADLassistance tasks.
The assistant does not work according to established appointments or schedules, but can be
called upon round-the-clock (day and night) via an intercommunication system with speaking
and listening function.
A second form is „living under guidance of a private person‟. This service is a kind of foster
care for persons with a disability, opting for a more independent way of living, while enjoying
the assistance they are in need of, rendered by a non resident, familiar, trusted person.
It is an alternative for the coached living service, but in this case rendered by a neighbour,
friend or relative, meant for adult disabled persons, able to organise their lives in a more
independent way.
Economic independence is an important condition; the person needs to be in a position to
pay for his living expenses by him- or herself.
Another form is „Coached or guided living‟. Coached living services care about the guidance
and assistance to adult persons with a slightly intellectual, sensorial or motorial disability,
living independently, hence in need of professional support. Until recently, coached living
was accessible for persons with a mental disability only.
All "clients" of the coached living service live independently (not at home or institute). They
are able of living as a couple, possibly with children or as a group consisting of maximum 4
persons.
There are two core-functions:
supporting function, focussed on living in the community as independently as possible ;
training function, promoting independence.
The guidance is mainly given by means of house calls. At least once a week, the guide
makes a house call. At the occasion of suchlike visits, all aspects of daily life can be talked
about. Also certain activities can be done jointly. Both, client and guide, but also important
third parties can introduce certain themes, even though the client and his expectations
remain of prime importance.
Apart from the house calls, there are regular activities, focussed on self development and
social integration. Those activities are non-committal and mostly concern leisure and
pastime. Sometimes educational activities are involved.
23
The persons, eventually considered for subject guidance, get nominated by next two
following criteria:
a slight mental, sensorial or motorial disability;
dispose of sufficient experience in living independently, while in need of subject
services.
The given examples are for adults who are able to live reasonably independent. There are
other services , especially created for adults who are less independent and need more
special support. These services include „sheltered living‟ which is organised by Zonnestraal,
your host today. A full explanation of their work follows shortly. But first we take a short look
at our institutions.
Care in an institution: (general explanation).
There is a difference between semi-residential and residential care. The centres with semiresidential care offer guidance during the day while at night and during the weekends, the
person with disabilities stays at home. In a residential centre, guidance during the night and
the weekend is provided. People with a less severe disability can go to school or to their
work during the day. The centres organise also activities for their inhabitants.
Let‟s concentrate on some possibilities for minors here.
A specific form of residential care are the centres for observation, orientation, medical,
psychological and pedagogical treatment. In other words: observation centres.
The target group of the observation centres are emotionally disordered and/or mentally
disabled minors. Before the actual registration, a request for admission, certified by a
psycho-medical-social report in needed.
The task of an observation centre is to conduct a multidisciplinary study about the neuropsychiatric, psycho-pedagogic and social aspects of the disability.
Consequently, a report is made of this, which states the advised treatment, pedagogical
approach and possible admission into a specialised institution.
In principle, the duration of stay is limited (to 3 months) but prolongation may be permitted.
Another typical form of residential care for minors are institutions with a boarding-system.
Institutions with a boarding system are also denominated as boarding establishments or
medical pedagogical institutions (M.P.I.‟s).
They offer permanent reception and assistance, every hour of the day, every day of the year.
The minors are usually educated during the day, or at least those minors who are mature
and capable of going to school. Non-school-going youngsters can make use of replacing
activities, treatment and assistance.
In addition to that, efforts are made to keep contact with the family of origin, f.i. the minor
stays at home during the weekends and during vacations. This implies that boarding
establishments have a family supporting or family replacing function.
Services for disposition in families. These services are responsible for disposition of minors
(and persons of age) with a handicap in families. The family has to provide housing, general
education and assistance. The service supervises in ambulatory fashion: it guides and
supports the family, and keeps up the necessary functional contacts. The service also has
24
to judge whether the admittance meets certain general sanitary requirements and it ensures
educational and moral qualities.
Homes for short stays. Also denominated as short stay centres.
In these homes the daily and nightly care for minors or persons of age with a disability is
organised.
The duration of residence is limited to 3 months per calendar year.
Their function is mainly family supporting, since they provide reception during the family‟s
difficult periods.
Next to the institutions with a boarding-system are the institutions with a semi-boarding
system (semi-residential). The obligatory opening-hours of the semi-boarding establishments
is from 8 AM until 6 PM.
For school-going youngsters, this implies that they have to be present 8 hours a day. Nonschool-going youngsters have to be present for at least 6 hours a day.
Institutions of this kind can be described as rather family supporting and familycomplementary. Sometimes they work to prevent placement in a boarding-establishment.
There is a range of extra facilities available for adults: day centres, occupational homes,
nursing homes …
(engelse uitleg beschikbaar indien nodig).
Central waiting lists: This organ looks for the most suitable form and place of assistance.
PAB (Personal Assistance Budget) ( additional Supplement 2)
For some people with a handicap assistance in a centre is not necessary. Some people
prefer to stay at home even tough they experience some practical problems. The assistance
of a personal coach can increase the independence of the person. People with this profile
receive a personal assistance budget from the VAPH. This budget enables them to organise
and finance their assistance as they wish. This personal assistant can help in various
situations; at home, in the classroom or even at work. In this situation, the person with a
handicap becomes the employer and the assistant the employee.
The care is organised in a collective way. People with disabilities were in the past always
received in a centre. All the assistance was organised in a collective way. There was little
attention for the individual needs. This changed a lot since the last 10 years. Now, the
individual person is considered because each person has its individual needs and wishes.
The introduction of the PAB was an important step forward to a more individual approach of
each person. Because of its success the VAPH wants to extend this principle with the
Personal Related Budget. The starting point of the PGB is the fact that every person should
tune his assistance to his own needs. The PRB wants to improve some points. The most
important goal of the PRB is the improvement of the emancipation and integration in the
society of the person with a handicap. It also wants develop a better image of the person,
his situation,… so that a better assistance can be matched. Another point that the PGB
wants to look for is the level of assistance. Some people need more assistance than others.
The level of assistance should be matched to the needs of the person. There should also be
more transparency about de financing and the budgeting. The law should be simplified and
the volunteer aid should receive a place in the sector. The PGB means in fact that the
25
person with a handicap receives a package with financial means with which he can buy and
organise his assistance as he wishes.
26
4. Early childhood intervention in Belgium
Each region has is own legislation and model of early childhood intervention. We try to give
a overview of the similarities and differences on several topics.
4.1. The start
Flanders ( 6 mil. habitants)
Brussels French speaking community
( 1 mil. habitants)

First projects started at the end
of the seventies

of the seventies

1990 first legislation in the
Flemish community

French community

2000 legislation for Brussels
Philosophy:
home based approach intervention
Philosophy:
guidance service
Wallonia (3,3 mil. habitants)
German speaking community ( 75.000
habitants)

of the seventies

Began1986

First legislation 1990

French community

Adaptations 1999

2004 legislation for Wallonia
Philosophy:
early childhood intervention
Philosophy:
early childhood intervention
27
4.2. Mission
Flanders

A home based pedagogical
support

Individual support in daily life
environment

Pedagogical intervention, social
and psychological support to
the child, the family and the
environment

Principal mission related to age
category and supplementary
mission depending on topics (
kindergarten, integration in the
school, leisure time,…)

the child, the family

Technical support
Wallonia
German speaking community

Guidance in daily life

Family guidance

Individual assessment up to 8
year


the child, the family and the
environment
Individual programs
(rehabilitation, educational
support, social and
psychological treatment,
diagnostic, integration,…

Prevention and detection
We see an evolution from the medical paradigm over the educational paradigm to a more
ecologic-systemic approach
 Family (home based approach)
 Network of the family
 Inclusion (collaboration with general services)
The philosophy depends from the start period. In the seventies the relationship between
parents and professional comes into the focus, new ideas are raising:
 Partnership (parent groups, parent as expert, agreement, …)
 Educational framework ( the necessity to involve special pedagogues or
psychologist on a universal level in each service)
 Self-support
28
4.3. Planning
Flanders ( 6 mil. habitants)
1 service for each handicap in each
province: Mental -, motor -, hearing - ,
visual disability and autism
( 1 mil. habitants)
no planning
7 services acknowledged for mission
1 preschool age
5 Provinces
20 services acknowledged for a specific
handicap
Wallonia (3,3 mil. habitants)
1 service for early intervention in a
community from at least 8000
children under 8 years of age.
German speaking community ( 75.000
habitants)
1 service for the German speaking
community
18 services acknowledged general
services and specified handicapped
4.4. Aged ranged
Flanders
0 – 66 year
Wallonia
0 – 8 year
0 – 66 depending on the mission
0 – 7 year
Do we need handicapped specific services?
The conclusion from the Belgoaid meeting was that you need the expertise about the
disability and that you acquired the special pedagogical approach.
Specified services includes the danger to exclude some children ( multiple handicapped
children , children with new and rather unknown disabilities,…)
General services included the danger to neglect the specific approach ( adapted stimulation
program, specific pedagogical handling, …)
29
Some services can give a long term guidance, in other legislations there is a rupture
between preschool en school aged, infants and adults,…
The conclusion from the Belgoaid meeting was that specific early childhood intervention is
suitable but with enough specific attention to it can be part of a larger guidance program.
4.5. Admission to the program
Flanders
Inscription in the Flemish Fund for
the social integration of disable
persons
Inscription in the French Fund must
only be suggest if the handicap is
severe
Provisional decision for 1 year based
on a simple medical attest
Definitive decision based on a
multidisciplinary report made by a
acknowledge diagnostic centre
Wallonia
Positive decision of the Wallon
Agency for the social integration of
disable persons
Inscription in the German Fund isn‟t
necessary
Provisional decision
Decision from another region
Prevention becomes more difficult if parents need a inscription and decision from the fund
for the social integration of disable people.
For some parents this inscription is one step to far.
Because of the necessity of an inscription you can not respect the individual private time that
some parents need.
A small threshold guarantee abuse
30
4.6. Working models
Flanders
Individual guidance contract
Home visit = session
Individual support ( individualised
program and annual evaluation )
Session = an intervention of at least
one hour at home in the family of the
child or in the secondary life
environment
Session = intervention at home, in
the service or in the secondary life
environment
Each service is acknowledged on a
number of home visits ( not on a
number of families) example : 1 service is
Services are acknowledged for a
number of families
Collaboration with other services
aknoledge for 3600 home visits
Individualised intervention program
Standards of the quality handbook
Wallonia
Individual guidance contract
Individualised guidance convention
Individualised intervention program
Collaboration with the network
Services are acknowledged for a
number of families
Guidance of the parents
Assessment of the child
Collaboration with the network with a
preference for general services
Service project
4.7. Grant
Flanders
Grants for salaries and activities
Grants in relationship to the number
of actual visits
Grants for salaries related to
categories and families
Wallonia
Annual convention negotiated with
31
the German Fund in relation to the
demands
32
4.8. Financial contribution for the parents
Flanders
€ 4,6 for each session ( home visit)
Signature of the parents
Wallonia
Maximum € 25 a month
Between € 1,32 and € 13,16 a month
depending on the demands and the
families
€ 8,95 for the first assessment
1 % of the family allowance with a
maximum of € 2,85 for each session
In Flanders parents has to sign for each home visit. Seventy percent of the sessions must be
done in home visits or in the kindergarten.
The report of the agency mentions that parents must be involved in the annual evaluation
and the individualised programs.
Certain legislations focus more on the collaboration with the network and the inclusion
33
4.9. Control and evaluation
Flanders
Control of the number of sessions
and the prescriptions of the
legislation
Control of the prescriptions of the law
(at least 2 sessions each month in
each family)
External and internal audits on
quality conform the standards of the
quality handbook
Account control
Pedagogical evaluation
Account control
Wallonia
Pedagogical evaluation
1. Global evaluation two time a year
Account control
Each three year a new
acknowledgement must be asked
and motivated
Annual internal evaluation
34
35
5. The Kangoeroe, home based early childhood intervention
5.1.Introduction
Early childhood intervention service.
Home-based pedagogical supporting program
Transdisciplinary model of early childhood intervention
The Kangoeroe started as a project in 1981 and is since 1989 licensed by the Flemisch
Fund as a home supporting service for children with disability and high risk children.
5.2.Mission
Professional home-based support for children in early intervention
5.3 Vision
The home based program of early intervention aims to innovate permanent the early
intervention program, especially in our vision on human nature, on handicap and on support
and treatment in the regular and alternative circuit
5.4 Global aims
To increase the competence of the child and the family
To increase quality of life
To turn over incapacity's into opportunities
Positive image building of disabled children and their families
5.5. Values
Partnership between parents and professionals
Double-two-sized intervention
– Double :children and parents
– Two sized therapeutically and emancipatory
Respect for the families and the children in their way of thinking, feeling and acting
5.6 Target group
Families with children with motor developmental problems
• Cerebral palsy
36
• Spina bifida
• Muscular dystrophy
• Syndromes
• Heart disease
• Without diagnosis
Babies at risk ( hypotonic or hypertonic of the muscles, feeding problems,...)
5.7 Population
We did the follow-up of 348 Families in 2008. All together we did 5403 home visits.
New annoucements : 139 families
Exit: 134 families
5.8 Team
Total 17 team members in the early intervention. Approximately 14 full-time.
We do approximately 5000 home-visits ( primary and secondary educational environment).
Weekly we meet each other in team.
5.9 Announcement
Examples
Example announcement by é-mail
Dear,
My little son is 8 month and he has following problems. He rolls always the same side and he is not
able to roll back. In spite of the fact that I have kept myself much busy with exercises for this
problem. He does the same movements during the night and a given moment he rolls to the border
of his bed and he is blocked their.
So he lies always on his stomach and he let drop down his heat into the mattress, without turning his
head. He can not breath any longer and than it’s panic. This night it was as worse that he hat to
spite. At the moment I came to his bed he didn’t react anymore, when I picked him up he was very
slack...
I really don’t know how to learn him to roll back. We see also that he always rolls in the same
direction. I’m desperate, I can ‘t sleep during the night and I’m anxious that I will arrive to late one
night.
My day-care mother gives me the advice to contact your service. Is it opportune to do?
Thanks for your reaction.
Examples announcement by telephone call
Telephone calls:
Katho ( 5 weeks ) is a part of a twin, she has problems with eating , she weeps terribly much. We
need a follow –up from the physical therapy, there are some spots into he white brain mass, on the
left part legs and arms eclampsia
37
Jasper (7 month ) premature 30 weeks, arm amputated to above the elbow. One kidney is only for
15 % active.
Bruno ( 27 month) delay in the psychomotor development due to a too small lord cortex. Different
neurological examination are current
Louise ( 8 weeks) probe feeding after intestine operation. She is still in the hospital. The parents
demand support with the probe feeding and the start with normal feeding by dismissal from the
hospital.
Lander ( 5 month) has problems with the left arm. He keep him always behind, if you bring the arm in
front he starts to weep. He don’t like to lay on his stomach.
Process
Secretary answers the telephone calls. They listen to the requests and writes down the
announcement on a simple registration form.
Collected information is restricted to the most necessary items
– Name of the child
– Date of birth
– Address
– Telephone number where we can reach the parents
– Who referred the parents to us?
– What is the problem from the perspective of the parents and what do they
want?
– General remarks: for example :
•
•
home visits in the evening parents both work
mother speaks Arabic, she already had two children but they both died ,one
immediately after birth, they other at the age of 21 months
An the end of the phone call, the secretary informs the parents about the intake procedure.
Within a week the parents will receive a telephone call from the home trainer to make an
appointment for a first home visit.
Rules of the announcement
We ask that the announcement is done by the parents themselves.
Social workers, medical doctors,... can do the announcement at the moment that the parents
are present in their office.
Announcement procedure is short and simple.
Announcers speak with one secretary (no annoying transferring).
Everyone who answers the phone is trained to registration the announcement.
On the telephone there is time to listen, we give no advise but we accept the feeling from the
parents and the way they experience the problems with their child.
38
We respect the way parents explain the problems and write down the requests in the words
of the parents.
If its very clear that the requests do not belong to our target group we refer parents to the
appropriate service. If in doubt we start the intake procedure
Principles of the announcement (supplement 3 )
Approachable
Available
Affordable
Proximity
Respect for the families way of thinking, feeling and acting
Partnership
39
5.10 Intake
Every week we have team meeting in the two early intervention teams.
At the start of the team the new announcements are divided under the staff.
Two team members ,a pedagogical and a therapeutically oriented person, become
responsible for the supporting of the family.
At least into one week they make appointment with the parents for a first home visit.
Both home trainers do the first home visit.
They have no additional information from referring persons or services, so they can keep an
open mind to the way the family will present themselves and his coping with the problem.
First visit is exciting: How will be the family? Who will be their for the first visit? Which child
shall we see? How will be the house?
We focus on the problems announced by the parents.
We try to give at least a small practical support by increasing the competence of the
parents.
We show how and what they can do.
Hands-on approach with the parents as active participants.
At the end of the visit: decision of starting the program and administration.
Throughout the program the home trainers will be the same as those at the intake.
Appointment for next visit at least within the week.
Intake report is made by the home trainers and is presented to the parents and at the team
meeting.
The format of the report is simple:
Format of intake report
• Date, name, address ,...
• Presentation of the family
• Anamnesis from the point of view from the family
• Day night rhythm - waking - sleeping
• Nutritional situation
• Motor development
• Mental, social, visual and hearing development
• First point of interests for the family and the home trainers
Principles of the intake
Home-based pedagogical supporting service
Comfortable for families
Included guidance
Double – two – sided intervention
Double children and parents
40
Two sided therapeutically and emancipatory.
Proximity
Decentralisation of services/provision
Meeting the needs of families and children
Interdisciplinary functioning
Co-operation with families
Team building approach
Stability of team members
Transdisciplinary model of early childhood intervention
Increase competence of professionals
More guarantee for global approach
Reduce number of professionals
5.11 The Guidance
Analogue to the principles of the intake
Actions are based on:
Requests and needs of the parents
Needs of the child
Transdisciplinarily
Cooperation with other services and specialists
Respect for the families and the children in their way of thinking, feeling and acting
Individual programs
Actions
• Support on several levels:
– Motor development
– Communication
– Speech development
– Nutritional problems
– Sleeping problems
– Behavioural problems
– Wellness of the child and family
– Play and toys
– Diagnostic process
– Medical consulting
– Fraternity
– Family problems
– Emotional support
– Special equipment
Group sessions
• Swimming groups
• Parent groups
41
•
•
•
•
•
Information sessions
Activities
Kangoeroe fair
BBQ
Family weekend
42
Home visits with the Kangoeroe
6.1 Home visits
Thuesday, February 24th
Dirk :
With Monica (Norway) to :
- Tibo : multiple problems
Chris :
With Cristina (Portugal) to :
- Fé : cerebral palsy
Els B :
With Kirsten (Norway) to :
- Jasper : amputation right arm
Els V:
With Otilia (Portugal) to :
- Ozcan : premature child
Ilse :
With Anna and Sabine (Austria) to:
- Klevia : severe multiple problems
Carla :
With Luisa ( Portugal) to
- Kyara : Erbs paresis
Wednesday, February 25th
Chris :
With Anna and Sabine (Austria) to:
- Quentin : mental problems
- Ciana : multiple problems, no speech, nutritional problems
Els B :
With Cristina ( Portugal) to :
- Jitske : developmental retardation
Els V :
With Monica (Norway) to :
- Mathias : older child, played a game with his brother and sister and worked around
handicap
Ilse :
With Luisa (Portugal) to :
43
-
Wouter : child with malformation of the head
Sabine :
With Otilia ( Portugal) to:
- Luna : multiple problems
Carla :
With Kirsten ( Norway) to :
- Bram : multiple problems, hypotonic, mental problem. No speech yet. Advice to start
with smog to stimulate the communication.
6.2 Discussion
The Grundtvig exchange people joined a couple of home visits on Tuesday afternoon and
Wednesday morning. They also had an explanation of the working model of the Kangoeroe.
Afterwards there was a discussion about the strengths and weaknesses of the Kangoeroe
model.
1. What do you appreciate in the way we operate at the Kangoeroe; towards the child,
towards the parents, towards the siblings, towards the broader environment ?
Norway :
- Individualized work, approach is adapted to the family and child; the goals are
adjusted.
- Positive to get a relationship with the child
- The continuity allows to see the development
- Very good to work at the homes
Austria :
- Perfect approach to work with the family and the child, creates lots of possibilities to
work
- Good feeling to find what is right for this person on this very moment
Portugal :
- Being in the field makes a good relationship and friendship with the child possible
- You know what you‟re doing
- You respect the time of the child, you wait for the answer of the child
- Cooperative listening to the parents, to their questions.
- You work through the strengths of the family; The siblings also belong to the family
- Towards the broader environment it was possible to go in discussion, information to
other professionals
2. What is your opinion on our dual-approach ?
Norway :
- Good idea to have different professions cooperate into the same family : makes it
possible to see the child as a whole person. Important to have a view of the family.
- Would be nice to see the 2 workers together.
Portugal :
44
-
In Portugal one person has the responsibility and can ask another specialist to go
along. Depends on the needs of the family.
- They‟re not always able to work in the home. It‟s a good thing to be close to the
mother. Different opinions. You can try together. Good to consider the parents; to
have them continue; to do a follow-up.
Kangoeroe :
At the introduction we inform them about our way of working: that we don‟t give
therapy, but show them, inform them what they can do themselves. We try to work as
much as possible with the parents or caregivers at the kindergarten.
Norway :
- There‟s also a cultural difference : people in Norway are not used to have small
children at home; they expect that everything happens in kindergarten.
Kangoeroe :
- Even so we try to show the parents that their handling is also very important.
- Sometimes it‟s hard for the parents. It‟s a confrontation. Sometimes it‟s easier to
have it happen in kindergarten. They might also push it away because of different
underlying problems (relational, financial , feelings).
Norway :
- Positive is also the continuity; you‟re very close to the family; allows you to ask more
difficult questions and to work on a good relationship.
- What if the relationship doesn‟t work ?
Kangoeroe :
- We don‟t analyze the problem. No discussion. They can change home trainer. This
happens only once or twice a year. Often because of a crisis situation. The first
people they meet, can be too strong for them.
3. Weaknesses : what‟s missing, where‟s room for improvement ? What do you have in
your system what we don‟t have ?
Norway :
- Sign language with babies ; mental age 12 months. Learning to speak with support of
gestures. Baby sign research in USA. Courses for parents.
Kangoeroe :
- We don‟t have speech therapists. We are less focused on communication. We‟re not
used to sign language. Speech therapists in Belgium don‟t work that way.
Would be very interesting to see.
Austria :
- The day care mothers get special training for handicapped children. Information
about handicaps.
Different countries, different systems : important to outline the differences : for instance
kindergarten in Norway, preschool in Belgium.
6.3 Summary
45
They liked our dual – approach working model and the fact that we go into the houses. Gives
a lot of possibilities to build up a good relationship and allows to see the child as a whole.
They would like to see more home visits and to see the two home workers at work in the
same family.
In Norway they focus a lot on communication and use sign language at very young age.
There‟s also a lot of structural and cultural differences between the countries and their
systems.
46
7. Meeting with the parents
On Wednesday evening a dinner was planned to enjoy a nice meal in attendance of parents
and be able to meet with them in a nice and cosy way.
The cooks of service were the Grundtvig people themselves who prepared each a special
dish from their country. First a list of ingredients had to be made up ( with some language
barriers). While the shopping was done, there was a walk in the Kalkse Meerssen, the
territory around our service.
The preparations were done for the meal (The recipes, which were frequently asked for, are
as promised set below !) and later on the parents arrived.
We had diner in little groups, where at every table there was a mix of countries,
„Kangoeroes‟ and parents.
The menu :
Norwegian tuna spread and bread
Portuguese tomato-soup with codfish
Belgian ham rolls with leaks and mashed potatoes
Austrian Appelstrüdel
It turned out to be a comfortable and relaxed setting where people felt at ease and where a
lot of exchange happened on several topics.
Some reactions of our parents :
“…I thought it was a very pleasant and interesting evening. It all were very kind and
spontaneously warm people. It was really good company…”
“…the concept was very good: several groups talking, while enjoying a delicious meal…”
“…all kinds of subjects around early childhood intervention came to discussion and I got an
answer to what I wanted to know.”
“… Very nice initiative ! Short, but good. Nice to be set at mixed tables. We each explained
our situation and the way the Kangoeroe worked, school-systems. The super inclusion of
the Portuguese system really touched me and made me look different to my daughter and
our situation…”
“ … it was a very nice evening. For me it was nice to hear what the worries and problems
were of other parents, but also to get acquainted with the foreigners and to hear how the
care is organized in their home countries. It was difficult to meet with all of them ( due to the
cosy setting at separate tables and too little time)…”
And finally…
The recipes !
Bread with tuna-spread ( Norway)
Smash the tuna with a fork and mix it with sour cream and mayonnaise. Add salt and
pepper.
Serve with bread.
47
Tomato-soup with codfish ( Portugal)
4 Servings
Ingredients:
- 4 large pieces of cod (or other fish)
- olive oil (as preferred)
- salt (as preferred)
- 1 large onion
- 3 garlic cloves
- 4 medium-sized potatoes
- 3 large, ripped tomatoes
- ½ green pepper
- a small branch of origan
- a small branch of pennyroyal
- a small branch of coriander
Directions
In a pot, prepare an onion, garlic and olive oil sauce. Cook them until the onion and the garlic are
transparent, add the tomatoes, peeled and chopped into small pieces.
Add 1 litter of hot water and simmer. Add the potatoes, cut into slices, and when the potatoes are
almost done, add the chopped herbs, the sliced green pepper and the cod, cut into 2 inches cubes
and season to taste (if you wish, you may add 2 raw eggs to the soup). Cook for 4/5 minutes, stirring,
until the potatoes are boiled. Serve.
Ham-rolls with Belgian chicory and mashed potatoes (Belgium)
Boil the Belgian chicory, let the water drip out and roll them into a slice of ham. ( 2 rolls a
person)
Sauce : melt butter and add flower. While stirring add milk until it boils and thickens.
Continue until you have 1 liter. Add salt and pepper and nutmeg. In the end add shredded
cheese.
Serve with mashed potatoes.
Apple strüdel ( Austria)
1 puff-paste (Blätterteig), 400 g apples ( peel and cut into fine slices), 50 g raisins, 50 g
sugar and cinnamon : mix all these ingredients.
Roast 50 g butter, 50 g sugar and 50 g bread crumbs together until light brown.
Keep all the ingredients in the middle of the puff-paste and put the right and left part of the
puff-paste over this filling.
48
Apply the puff-paste with a cracked egg and bake it in the oven by 180°C for 30 minutes.
Enjoy !
49
50
8. Evaluation meeting
The visit to the institution for severe multiple handicapped children was considered as good
and very interesting. It was a pitty that we didn‟t see the school (holiday time).
The evening with the parents was very nice and interesting. There were discussions about
their own child and also about other topics.
For the next visit, they ask
o A visit to a special school
o A visit to normal crèche
o More home-visits
o More time to discuss after the visits
This visit we learned about the organization of early intervention in Belgium. The previous
visit learn about the Norvegian system and the next time (in Graz) we will learn about the
system of Austria.
Not every visit within the project is with the same people. From every service, several people
want to visit at least one country. That means that we often have to deal with new members
in the group.
We try to look for a way to inform those new people about the different workingmodels in the
different countries, so we don‟t have to repeat it every time.
By making that form, we also try to make clear what is meant by some words. There seems
to be a big difference between the organization of childcare in the different countries.
For example : kindergarten in Austria is for children from 3 ‘till 6 years old. For us, in
Belgium, kindergarten is for children under 3 years.
This brings up a lot of confusion and a waste of time. We decided to make extended reports
about the national situation so that the other team members can read the reports.
Planning
Next meetings :
May 2009
Sept 2009
Nov 2009
Feb 2010
May 2010
week 22
week 39
week 47
week 6
week 18
Graz
Kristiansand
Gent
Kristiansand
Graz
Program Austria May 2009
- Different networking with early intervention
o Inclusion
o Overview possibilities
- Invite responsible persons to discuss with
- Home visits
- A visit to an institution?
51
-
Kindergarten with a mix of handicapped children and “normal” children
Theoretical models about working in kindergarten
Presentation about the system in Portugal  film made by the Portuguese members
about inclusion of a child in kindergarten and school
Accomodation: Anna will send suggestions by e-mail.
52
Supplements
53
Supplement 1 Social security in Belgium
Background
The Belgian social security system, as is the case in many other countries, can be traced
back to solidarity mechanisms of the crafts and guilds. It was influenced by the Atlantic
Charter and the French and British examples but is essentially a Bismarckian system where
it is compulsory for people to be insured and people acquire rights by working. Just as in
previous centuries, those who were not involved in the world of work had assistance to fall
back on.
Since the end of the 19th century, social legislation and provisions have been introduced but
the social security system in its current form - a system organised by the state and based on
compulsory insurance - was established in 1945. It had already been planned before
Belgium was completely liberated. Employers' and workers' representatives, who had
frequently worked together during the occupation in a bid to protect workers or to commit
sabotage, met to prepare how post-war Belgium would be organised. Their meeting led the
draft Agreement on Social Solidarity to be signed on 19 August 1944. It was incorporated
into the Decree on social security signed by Prince Karel, who was ruling at the time since
his brother Leopold II was still imprisoned in Germany, on 28 December 1944 - the same
day that Germany launched the Ardennes Offensive.
In the years following the war, the system was developed further. It was still some time after
the Golden Sixties before people realised that the Western European economies were facing
a structural crisis. So, the social partners continued to expand the system with generous
provisions until it became clear that financing the system threatened to become problematic.
In the second half of the 1970s, a series of innovative measures were introduced to promote
employment and systems such as the pre-retirement pension system were set up. Since the
1980s, measures have been taken to limit expenditure.
Since then, the problem of the aging of the population has become increasingly apparent.
The ever larger number of elderly people generates higher health care costs year after year.
This development and the anticipated huge increase in spending on pensions as the baby
boom generation retires, prompted the government to set up a reserve for the future called
the Silver Fund.
Financing
The social security system is financed by contributions from employees and employers and
subsidies from the state. The amounts are calculated based on the gross salary (basic
salary plus bonuses, benefits in kind an so forth) and are paid to the National Office of Social
Security (ONSS/RSZ). Employees contributions finance approximately 13% of the social
security system. Employers' contributions account for over 34%.
Over the last few years, other sources of income - a percentage of the income from VAT have also been used in order to reduce the contributions paid by the state and to ease the
54
burden on employers so that labour becomes cheaper. Approximately 96% of this money is
used to finance the system for salaried workers, the rest goes to systems for self-employed
persons.
The social security system for self-employed persons has been around since 1967. Selfemployed persons have to join a social insurance fund. They pay a contribution, which
corresponds to a certain percentage of their net income. The insurance funds for selfemployed persons are controlled by the National Institute for the Social Security of the Selfemployed (RSVZ/INASTI).
In 2001, the government set up the Silver Fund in a bid to ensure that the social security
system could continue to be financed in the future. The Silver Fund will be composed of
budget surpluses and surpluses from the social security system. At the end of 2004, the
Fund already contained almost 12 billion EUR, which corresponds to 4% of GDP. As from
2007, the budget will have a surplus that should amount to 1.5% by 2011.
Organisation and departments
Included within the social security system are the systems that provide replacement incomes
in the event of unemployment, retirement or the inability to work, support for financing costs
such as child support or health care and annual paid holidays. In fact, there are three
systems: one each for salaried workers, civil servants and self-employed persons. For
salaried workers, special regulations apply to certain professions.
For those who do not fall into one of these categories, various forms of social assistance are
available: integration income (previously referred to as the subsistence minimum),
guaranteed income for the elderly, guaranteed family benefits and disability benefits.
The Federal Minister for Social Affairs is responsible for all the benefits except
unemployment compensation which falls within the remit of the Minister for Employment. In
addition, some large organisations play an important role. The National Office of Social
Security collects the contributions and divides up the funds between the various
organisations that deal with the payment of benefits.
Family benefit
Child benefit is granted to salaried workers, self-employed persons and civil servants but the
criteria for granting the benefits and the amounts differ. The benefit does not just comprise
conventional child benefit but also a birth grant (paid at the earliest two months before the
birth), an adoption allowance (paid in the case of adoption), an increased orphan's
allowance and additional benefits.
There is also the guaranteed family benefit for those people who, for one reason or another,
are not covered by the regulations for salaried workers, self-employed persons or civil
servants.
Annual paid holiday
55
As far as holidays are concerned, there is a difference between workers and employees.
The National Holiday Allowance Office (ONVA/RJV) provides holiday allowance for the
former and the employer provides it for the latter. The number of days of paid holiday
depends on the number of days worked during the previous year.
Health care
Workers have to join a health insurance scheme. The health insurance provided does not
just cover the insured person but also any dependents (for example, children or an
unemployed spouse). Virtually everyone is entitled to this insurance. Medical care is divided
up into several categories and depending on the type of care, the cost is partially or fully
refunded according to certain rates. Medication is also divided up into different categories.
There is a rule for self-employed persons according to which they are only insured for major
risks. Those people who want to also be insured for minor risks can take out extra insurance
with their health insurance scheme. In this case, the person is also partially reimbursed for
consultations with doctors and specialists, certain dental treatments and so forth.
The contribution made by the individual towards the costs is referred to as the personal
share. To make up for the increases in the personal share, the concept of maximum billing
has been introduced. This provides a guarantee to patients that their annual expenditure for
health care shall not exceed a certain limit, which is dependent on their income.
The reimbursement of medication and medical care is usually made at a later stage. The
health care provider gives the insured person a certificate, which he/she must submit to
his/her health insurance scheme in order to be reimbursed for the medical care provided.
The person is reimbursed according to a rate which depends on the type of care, the health
care provider and his/her personal status (widow(er), pensioner, older unemployed person,
disabled).
The third party payment scheme is applied for care provided in hospital and for medication.
In other words, the hospital only asks the patient to pay their personal share of the costs and
collects the rest directly from the health insurance fund.
The same system is used for medication. The insured person presents the prescription to
the pharmacist who only charges the client for their personal share. Some types of
medication are free (usually those prescribed for serious or long-term illnesses) but for
others, patients have to pay a certain percentage of the cost themselves, which is
sometimes as much as 80%.
Work incapacity benefits
Workers who have been declared unfit to work as a result of illness receive a benefit. The
majority of these people initially receive a guaranteed income paid by the employer, which is
usually paid out for 14 days for workers and 30 days for employees.
After this period, they receive a work incapacity benefit, the amount of which varies
depending on their previous salary and the duration of their incapacity to work.
For the first 30 days, the benefit represents 60% of their former income (with a ceiling). After
56
the 30th day, single people and people with dependents continue to receive 60%, cohabiting
couples only receive 55%. As from the first day of the seventh month, a minimum amount is
paid that takes account of the person's family situation.
Self-employed persons who become ill receive a fixed sum.
Maternity and paternity
Women are entitled to a benefit during their maternity leave. For the first 30 days, the benefit
represents 82% of their salary, after this time it amounts to 75% of the salary, subject to a
ceiling. Women are entitled to 15 weeks maternity leave, eight of which must be taken after
the birth and at least one week must be take before the date when the baby is due. When a
child is born, the father has a right to 10 days paternity leave, seven of which are paid for by
social security. These seven days are paid at 82% of the salary, subject to a ceiling. There is
also a regulation for parental leave in the event of an adoption along with similar benefits.
Occupational illnesses
There is a list of disorders which are recognised as occupational illnesses and which entitle
the person suffering from one the disorders to compensation. People who suffer from an
illness not included on the list, must prove that there is an established and direct link
between the illness and their work.
All workers and civil servants are insured against occupational illnesses, self-employed
persons are not.
Accidents at work
Workers are covered by an insurance against accidents at work, which each employer is
obliged to have. Not only incidents which occur at the workplace but also accidents which
happen on the way to or from work are classed as accidents at work.
Self-employed persons are not insured against accidents at work. A separate rule applies to
civil servants.
Unemployment
Workers who lose their job are entitled to unemployment benefit, but they must fulfil certain
criteria: they must have worked a certain number of days within a reference period or a
certain number of days that are deemed to be equivalent. The number of days depends of
the age of the unemployed person. In principle, people who resign or are dismissed as a
result of serious misconduct are not entitled to receive a benefit.
Young people who have just left school but have not yet found work also receive a limited
benefit after a qualifying period.
Unemployment benefit is calculated on the basis of the previous salary but there is a ceiling
(approximately ¿1,743 gross per month). Family situation is also take into account. The
benefit has no time limit but long-term unemployed people may be excluded from the system
if they do not make sufficient efforts to find work.
Cohabiting couples with dependents receive 60% of their previous salary (or of the
57
maximum reference salary) for the entire time that they are unemployed. Single people
receive 60% during the first year and 50% from the second year onwards. Cohabiting
couples with no dependents receive 55% during the first year. The benefit is then reduced
taking account of the number of years the person in question has already worked. The
benefit can be reduced to 397 EUR.
Unemployment benefits are paid out by the benefit payment agencies: these are the unions
for people who are members of a union and the Auxiliary Unemployment Benefits Fund for
people who are not members of a union. Unemployment insurance is intended for workers.
Self-employed persons who lose their job are not entitled to the benefit.
Temporary unemployment
There is also a benefit for temporary unemployment. Workers must have worked for a
certain number of days to be eligible for the benefit. It is somewhat higher than the benefit
for the full time unemployed. Cohabiting couples with dependents and single people both
receive 65% of their previous salary.
Time credits
People who want to work less or stop work completely for a short period so that they can
look after a sick person or spend more time with their children, for example, are able to do
this under the time credits system. Workers can take a complete career break or work less
hours for a certain period. It is possible to stop work completely or reduce working hours by
half or a fifth.
During the break or reduction in working hours, the workers in question receive an
interruption allowance. There are restrictions: in companies with less than 11 workers, the
employer is not obliged to allow this sort of career break. In larger companies (unless the
sector has decided otherwise), no more than 5% of the workers are allowed to be on a
career break. There is a special regulation for workers over 50.
Pre-retirement pension
The pre-retirement pension is intended for older workers who have been laid off. In addition
to their standard unemployment benefit they can also receive additional compensation. The
pre-retirement pension made it possible for companies to lay off workers relatively easily.
The fact that the pre-retirement pension eased the financial impacts of unemployment, often
overcame most of the resistance to it. The aim was also that young people should be taken
on to replace the older workers, however, for the most part, the system did not achieve the
desired effect. The system was very expensive and had an extremely negative effect on the
employment rate of older people. The system will now be scaled down as a result of the
Generation Pact which has recently been set up.
Pensions
The retirement age is 65 for men and used to be 60 for women but it has gradually been
increased over the last few years. By 2009, the retirement age for women will also be 65.
On average, workers retire at the age of 57 which means that many Belgians are included in
a different 'retirement category' (early retirement, pre-retirement pension) before they reach
58
the age of 65. They are entitled to a statutory pension but this is increasingly complemented
with a supplementary pension. Individual and sectoral pension plans which have tax
advantages for workers and are supervised by the government constitute the second pillar of
the pension system. The third pillar is composed of pension schemes and individual life
insurance.
Approximately 44% of the population has a pension scheme, which is a form of investment
that enables people to build up capital in a fiscally advantageous manner by the time they
retire. As regards the statutory retirement pension, people build up entitlements to this type
of pension by working. There is also the survivors' pension which is granted to the spouse
following the death of the person entitled to the pension.
The schemes differ depending on whether the retired person was a salaried employee, a
self-employed person or a civil servant. For those people who have fallen into more than one
of these categories during their career (for example, someone who was self-employed and
also worked as a salaried employee), the rights acquired in the various systems are
combined. The entitlements correspond to the number of years worked and the salary
earned. Family situation is also taken into account. A ceiling applies to the salary used as a
basis for calculating pensions. There is also a minimum pension. Workers with dependents
receive 75% of their average salary for each year worked. Single people receive 60%. The
ceiling for calculating pensions is approximately 39,000 EUR per year.
In 2004, state spending on pensions totalled 9.3% of GDP. This figure will increase to 12.3%
by 2030. Self-employed persons can set up a supplementary pension either with social
insurance funds or with private insurance companies.
International agreements
There are a number of international agreements in force pertaining to social security for
Belgians abroad or foreign nationals in Belgium. The general principle is that workers are
included in the system of the country where they work. This does not apply to posted
workers.
Social Assistance
People who are not included in the social security system can be helped by social
assistance. The objective of social assistance is to ensure that each person living in the
country has the right to integration, which in essence means the provision of a minimum
income. In this case too, a number of conditions need to be met in terms of the means of
existence of the person in question, for example. Social assistance is the responsibility of the
Social Assistance Centre (CPAS/OMCW), a body which is present in each municipality. The
CPAS/OMCW helps people by providing them with an integration income or by helping them
to find work. It also supports these people during their integration. People can also go to the
CPAS/OMCW to seek help with debt management and legal problems. Guaranteed family
benefits, guaranteed income for the elderly and disability benefits are also included under
social assistance.
Disabled people receive an allowance in line with their age and level of disability. The
parents of disabled children receive more child benefit if the child is at least two-thirds
disabled. The benefit is paid until the disabled person is 21. Once they have reached this
age, the disabled person themself receives an income replacement benefit if they can prove
59
that their ability to earn an income is two-thirds lower than that of a non-disabled person. The
disabled person receives an integration allowance if a medical examination shows that the
person's independence is restricted (ability to move about, feed and look after themselves).
The SIS card
Belgians don't just have an identity card, they also have a social identity card, known as a
SIS card. It looks just like a bank card and contains a person's individual number for the
social security system. Each time the person has any contact with the organisations in the
social security system, their card is read so that there is no confusion about the person's
identity or their status within the system. The SIS card is also used by employers who have
to pass on details about their employees to the social security system. The card must also
be presented in pharmacies when a patient is picking up medication, at consultations, in
hospitals, for reimbursements by the health insurance schemes and so on.
The central social security databank
A few years ago, a central social security databank was set up for the social security system.
This databank has enabled administrative costs to be reduced since it brings together all
data on insured persons in one single place. Each body in the social security system is able
to consult the data. This marks a significant improvement since previously, employers and
insured persons had to submit data, which they had perhaps already provided to other
bodies, every time to each body. The data can also be consulted by other bodies provided
that they have been granted access, for example transport companies that use social tariffs,
health care providers and so on.
60
Supplement 2 The Personal assistance budget
Over the years the Vlaams Agentschap voor Personen met een Handicap (VAPH) has
developed a varied range of provisions and services for the disabled. And yet it appears that
a large group of people prefer not to make use of these. These people opt to stay at home
and to organise their care themselves. The Personal Assistance Budget was developed to
meet (in as far as is possible) the demands of these very people.
The Personal Assistance Budget (abbreviated to PAB) is seen as an alternative to the
current range of care services. The disabled person or his legal representative (the budget
keeper) receives a budget with which he is free to organise and finance his care himself. In
other words the budget keeper takes his care needs into his own hands. This he can do by
employing personal assistants, for whom he is in fact the client.
The PAB is a budget which the VAPH allocates the disabled person or his legal
representative to cover some or all of the expenses of personal assistance and its
organisation.
A personal assistant is an adult who provides personal assistance under contract with the
disabled person or his legal representative.
Personal assistance is the work carried out by the personal assistant with a view to assisting
or accompanying a disabled person in the organisation of his day-to-day life and in
advancing his social reintegration.
People who are awarded a PAB are entitled to an index-linked annual budget. It is not
issued in one go, but as a quarterly payment.
The expenses for which the PAB can be used break down into two parts, i.e. direct and
indirect expenses. Direct expenses are expenses which arise as a direct result of being an
employer/client. Direct expenses are therefore expenses which arise directly or indirectly
through the conclusion of an employment or other contract. Indirect expenses are expenses
which relate to the PAB but which cannot be considered direct expenses. Indirect expenses
are therefore expenses which do not arise directly or indirectly through the conclusion of an
employment or other contract. Every expense, whether direct or indirect, must be evidenced
by means of invoices, wage slips, receipts, etc.
61
Direct expenses can be covered under the following types of contract:
- an employment contract with the personal assistant
- a contract with a temporary employment agency
- a contract with an independent service provider
- a contract with an organisation or facility which provides salaried personal assistants
for the budget keeper to cover assistance outside the organisation or facility
- a contract with a VAPH facility offering short-stay accommodation or lodgings
- a contract for PWA cheques
- a user contract with a service company (service cheques)
- a contract with a relative (to twice removed) or a person belonging to the budget
keeper‟s family
The above contracts are designed to advance a disabled person‟s social integration and
participation by supporting and optimising his/her independence and quality of life.
62
Supplement 3
From Early Childhood Intervention
Analysis of Situations in Europe
Key Aspects and Recommendations
Summary Report
European Agency for Development in
Special Needs Education
ISBN: 8791500-60-5 (Electronic)
8791500-42-7 (Printed)
2005
European Agency for Development in Special Needs Education
Secretariat:
Brussels Office:
Teglgaardsparken 102
3 Avenue Palmerston
DK-5500 Middelfart Denmark
B-1000 Brussels Belgium
Tel: +45 64 41 00 20
Tel: +32 2 280 33 59
Fax: +45 64 41 23 03
Fax: +32 2 280 17 88
[email protected]
[email protected]
www.european-agency.org
1. 3. RECOMMENDATIONS
The following recommendations are based on the principle that early childhood intervention
is a right for all children and families in need of support. Taking into account the results from
the analysis presented in the previous chapters, a number of relevant features emerge and,
therefore, need to be properly implemented. The following recommendations aim to help
professionals become aware of adequate strategies for the implementation of these relevant
features and help them avoid existing barriers – all for the benefit of children and their
families. These recommendations, based upon the results of the project meeting
discussions, are also considered to be of interest to policy makers despite the fact they are
mainly addressed to professionals working, or planning to work, in this field.
The five main features mentioned in chapter two are presented below, along with a nonexhaustive list of recommendations aiming at their successful implementation.
2. 3.1 Availability
In order to ensure that ECI reaches all children and families in need as early as possible, the
following recommendations are proposed.
Existence of ECI policy measures: at local, regional and national levels, policy measures
should guarantee ECI as a right for children and families in need. ECI policies should
enhance the work to be jointly undertaken by professionals together with families, by
63
defining ECI quality and evaluation criteria. Taking into account the situation in different
countries, three issues require particular attention:
1. Families and professionals need policy measures that are carefully co-ordinated in
terms of strategies for implementation, objectives, means and results;
2. Policy measures should aim to support and ensure co-ordination of the education,
social and health services involved. Overlapping or contradictory measures within or
across the services should be avoided;
3. Policy measures might include developing regional and national ECI support centres,
acting as a link across the policy, professional and user (family) levels.
Availability of information: as soon as required, extensive, clear and precise information
about ECI services/provision should be offered at local, regional and national levels to
families and professionals from all services. Special attention should be paid to the use of
precise, but accessible language. In the case of families from different cultural backgrounds,
their preferred language is to be used in order to avoid excluding them from access to any
relevant information.
Clear definition of target groups: policy makers are the group to decide on ECI eligibility
criteria, but professionals should co-operate in an advisory role. ECI centres, provision,
teams and professionals should focus on the defined target groups, according to the
priorities established at local, regional and/or national levels. Contradictions across levels
may cause distortions and, as a consequence, children and families might not get support or
not be able to access adequate resources.
3. 3.2 Proximity 2
In order to ensure that ECI provision and services are available geographically as close as
possible to the families and are family focused, it is important to take the following into
account.
Decentralisation of services/provision: ECI services and/or provision should be located as
close as possible to the families in order to:
- Facilitate better knowledge of the conditions of the families‟ social environment;
- Ensure the same quality of service despite differences in geographical location (e.g.
scattered or rural areas);
- Avoid overlaps, irrelevant or misleading pathways.
Meeting the needs of families and children: services and provision should exert the
necessary effort in order to reach families and children and meet their needs. This implies
that:
- Families have the right to be well informed from the moment when the need is
identified;
- Families have the right to decide, together with professionals, on the next steps to be
undertaken;
2
Proximity is considered in this document to have a twofold meaning: near to a place and near to a
person.
64
-
-
ECI cannot be imposed onto families, but should guarantee the right of the child to be
protected. The rights of children and families need to converge;
Families and professionals share an understanding of the meaning and the benefit of
the type of intervention recommended to families and the child;
The development of a written document (such as an Individual Plan, Individual
Family Service Plan, or equivalent) prepared by professionals together with families,
facilitates transparency and common agreement on the ECI process: planning of
intervention, formulation of goals and responsibilities, evaluation of results;
Families should receive training upon request, which would help them obtain the
required skills and knowledge, therefore facilitating their interaction with professionals
and with their child.
4. 3.3 Affordability
In order to ensure that ECI provision and services reach all families and young children in
need of support, despite their different socio-economical backgrounds, it is necessary to
ensure that cost free services/provision is made available for the families. This implies that
public funds should cover all costs related to ECI through public services, insurance
companies, non-profit organisations, etc, fulfilling the required quality standards stated in the
respective national ECI legislation. In the case where private ECI provision, at the entire cost
of the family, co-exists with publicly funded services, quality standards defined by the
national ECI legislation must be implemented.
5. 3.4 Interdisciplinary working
Early childhood services/provision involves professionals from various disciplines and
different backgrounds. In order to ensure quality teamwork, the following recommendations
are suggested.
Co-operation with families 3: as the main partners of the professionals, this co-operation
should be ensured, taking into account that:
- Professionals have to initiate co-operation and have an open and respectful attitude
towards the family, in order to understand their needs and expectations and avoid
any conflict arising from different perspectives on needs and priorities, without
imposing their point of view;
- Professionals should organise meetings in order to discuss the different points of
view with parents and together set up an agreed written document, called an
Individual Plan or similar;
- An Individual Plan (IFSP or equivalent) should present an agreed plan stating the
intervention to be conducted, as well as goals, strategies, responsibilities and
evaluation procedures. This written agreed plan should be regularly evaluated by
families and professionals.
Team building approach: despite their different backgrounds, corresponding to their
disciplines, ECI teams/professionals should work in an inter-disciplinary way before and
3
Co-operation is used in the text in the sense of families and professionals working together, both
providing their own expertise and combining efforts and responsibilities.
65
whilst carrying out the agreed tasks. They need to share principles, objectives and working
strategies. The different approaches must be integrated and co-ordinated, reinforcing a
comprehensive and holistic approach, rather than a compartmentalised one. Special
attention should be paid to the following issues:
- Information needs to be shared in order for team members to complement each
other, according to both their individual skills and competences;
- Decisions should be taken by the team/professionals following discussion and
agreement;
- A contact person should be nominated in order to co-ordinate all necessary actions,
ensure permanent contact with the family and avoid numerous unnecessary
unilateral contacts between the services and the family. The contact person should
be the reference person for the family and the professional team. S/he should be
nominated according to the skills required for each specific situation;
- Professionals from different disciplines need to know how to work together. Common
further or in-service training should be organised in order for professionals to share
common basic knowledge related to child development; specialised knowledge
related to working methods, assessment, etc, and personal competences on how to
work with families, in a team, with other services and on how to develop their
personal abilities.
Stability of team members: teams should be as stable as possible in order to facilitate a
team building process and ultimately quality results. Frequent and unjustified changes of
professionals might affect the quality of the support provided as well as teamwork and
training
6. 3.5 Diversity
In order to ensure that the health, education and social sectors involved in ECI services and
provision share responsibilities, the following recommendations are suggested.
Adequate co-ordination of sectors: the variety of sectors involved should guarantee the
fulfilment of aims of all prevention levels through adequate and co-ordinated operational
measures. This implies that:
- Health, education and social services should be involved in early detection and
referral in order to avoid gaps or significant delays that might affect further
intervention as well as waiting lists in the case of overloaded services or teams;
- Developmental screening procedures are there for all children. They need to be well
known and systemically implemented;
- Consistent monitoring, advice and follow-up procedures need to be provided to all
pregnant women.
Adequate co-ordination of provision: good co-ordination is necessary in order to guarantee
the best use of the community resources. Good co-ordination means that:
- Services should ensure continuity of the required support when children are moving
from one provision to another. Families and children should be fully involved and
supported;
- Preschool settings should ensure a free place to children coming from ECI
services/provision.
66
As mentioned above, these recommendations are mainly addressed to professionals
working or planning to work in this field, but they also concern decision-makers at the policy
level. This is why an evaluation of impact of ECI policies should be regularly carried out and
communicated in order to promote discussion and to stimulate research in this field. It should
be taken into account that early childhood intervention policies are the common
responsibility of families, professionals and policy makers at local, regional and national
levels.
67
68

Meeting 2, Belgium, 2009 February

Transcription

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