CHILD DEVELOPMENT

and

REHABILITATION SERVICE

IN SINGAPORE

KEY DEMOGRAPHIC STATISTICS SINGAPORE 1957 - 2000

1957 1970 1980 1990 1998 2000

Resident Population 1,445.9 2,074.5 2,282.1 2,705.1 3,163.5 3,263.2

(‘000)Age % < 15 years 42.8 38.8 27.6 23.2 22.5 21.5 % 15 - 64 years 55.0 57.9 67.5 70.8 70.4 71.2 % 65 yrs & above 2.1 3.3 4.9 6.0 7.1 7.2

Median Population Age 18.8 19.7 24.4 29.8 32.9 33.8(years)

Dependency Ratio ( per 100 persons aged 15-64 )

Total 81.7 72.8 48.2 41.3 42.7 42.5 Young (<15 yrs) 77.8 67.0 41.0 32.7 32.0 31.7 Old (65 yrs and above) 3.9 5.8 7.2 8.6 10.7 10.8

POPULATION and VITAL STATISTICS SINGAPORE 1957 - 2000

1957 1970 1980 1990 1998 2000

Crude Birth Rate 42.7 22.1 17.6 18.4 13.2 13.6(per 1000 population)

Crude Death Rate 7.4 5.2 4.9 4.8 4.6 4.5(per 1000 population)

Total Fertility Rate 6.41 3.07 1.82 1.87 1.50 1.43(per woman 15-44 yrs)

Life Expectancy at Birth (years)

Male 60 63.5 67.5 70 75.2 76.0

Female 65 68.5 74 75.5 79.3 80.0

VITAL MORTALITY STATISTICS SINGAPORE 1940 - 2000

Still-Births Infant Neonatal Perinatal Maternal

Rates Mortality Mortality Mortality Mortality 1940 20.8 142.6 42.8 N.A. 4.3 1950 17.1 82.2 29.8 35.4 1.8 1960 14.1 34.9 17.7 27.9 0.4 1970 9.7 20.5 14.6 21.5 0.3 1975 7.6 13.9 10.2 16.6 0.3 1980 6.4 9.3 8.9 13.4 0.0 1985 5.3 8.0 7.0 10.8 0.0 1990 4.0 6.6 4.7 7.3 0.0 1995 2.9 3.8 2.1 4.3 0.0 1998 3.0 4.1 2.4 4.9 0.1 2000 2.9 2.5 1.7 4.3 0.1

PRINCIPAL CAUSES OF DEATH SINGAPORE 1950 and 2000

1950 2000Tuberculosis (12.0%) Cancer (27%)

Infantile convulsions (11.1%) Heart diseases (25.1%)

Pneumonia (10.9%) Cerebrovascular disease (10.4%)

Gastroenteritis (8.9%) Pneumonia (11.4%)

Diseases of early infancy (6.6%) Accidents//Violence(7.2%)

Heart disease (4.6%) Diabetes Mellitus (2.3%)

Accidents (4.0%) Nephritis/Nephrosis (1. 3%)

Chronic Lung/Asthma (3.3%) Chronic liver disease (0.7%)

Cancer (2.8%) Chronic Lung/Asthma (0.7%)

Beriberi (2.0%) Septicaemia (0.8%)

LEADING CAUSES OF INFANT MORTALITY SINGAPORE 1960 and 2000

19601. Birth injuries, postnatal asphyxia & diseases peculiar to infancy

(37.5%)

2. Gastritis, duodenitis, enteritis and colitis (14.4%)

3. Pneumonia (14.4%)

4. Infections of the newborn (7.0%)

5. Congenital anomalies (6.0%)

20001. Congenital anomalies (42.8%)

2. Extreme prematurity and related perinatal conditions (38.0%)

3. Pneumonia and septicaemia (6.8%)

4. Heart disease (2.9%)

5. Accidents (2.6%)

CHANGING HEALTHCARE NEEDS for SINGAPORE CHILDREN

• Mortality rates have fallen to very low low levels & are now associated with conditions that modern medical care cannot affect. e.g., stillbirths of unknown cause, serious congenital malformations and genetic disorders, low birth weight, accidents and cancer.

• The traditional mortality rates are no longer adequate indices of medical care.

• Other population-based indices must be developed to enable proper evaluation of “how we are doing” in the provision of medical services to mothers and children

CHANGING HEALTHCARE NEEDS THE “NEW MORBIDITY”

• While the diagnosis and treatment of many serious diseases and injuries have become effective and efficient, the effective prevention or treatment of chronic diseases, disabilities, learning problems and behavioural disturbances, injuries and neglect , and unhealthy lifestyle behaviours have become major health problems.

• Many of these problems are not new. They are just becoming proportionately more significant and more prevalent in our society.

CHANGING HEALTHCARE NEEDS THE “NEW MORBIDITY”

• These problems demand much more than just clinical

diagnosis & treatment, as they must take into account

a wide range of personal, family, educational & social

factors.

• They are difficult to classify, to identify, to treat and to

prevent, as multiple aetiological factors are involved;

and medical and other health interventions may not

always be the most appropriate or effective means of

providing help to these children.

PARADIGM SHIFTS CHILD HEALTHCARE DELIVERY

• The road to continuing improvement in health does not

lie in further development and funding of expensive

hospital services and high-technology medicine.

• Increasing expenditure on hospital services will not lead

to significant improvements in the national health status.

• There must be a better balance established between

curative and preventive health care, between hospital

and community services, and between biomedical,

epidemiological and social research and education.

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE : THE EARLY YEARS

1947 Trafalgar Home : Children physically disabled with

leprosy received classes conducted by volunteers

1949 Red Cross Society : Home for crippled children

1951 Red Cross Society : Education for deaf children

1951 Singapore Association for the Blind

1952 Singapore Children’s Society : Social support for

children with social problems.

1956 Singapore Association for the Blind : Established

own school at Toa Payoh Rise: SAVH

1957 Spastic Children’s Association

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE : THE EARLY YEARS

1951 Red Cross Society : Education for deaf children

1955 Singapore Association for the Deaf (SAD)

1963 School for the Deaf set up to offer primary school

curriculum to deaf .

1975 Vocational School for the Handicapped to train deaf

youths to be skilled workers.

1957 The Canossian School for the Hearing Impaired

at Aljunied Road, shifted to Jalan Merbok in 1970.

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE

1961 Towner Road Centre

1962 Singapore Association for Retarded Children (SARC)

1965 Geylang Centre

1968 School for SARC : Lee Kong Chian Gardens School

1968 Jurong Gardens School

1983 Towner Gardens School

1986 Yio Chu Kang Gardens School

1995 Guillemard Gardens School

1985 Renamed MINDS : “Movement for the Intellectually

Disabled of Singapore”

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE

MINDS

• 5 special education schools

• Employment development centres

• Tampines Home 1969

Residential home for the very severely disabled,

especially those with inadequate family support

Relocation in 1992 to Thomson Road next to

Mt.Alvernia Hospital because of redevelopment of

Woodbridge Hospital, but retained the same name.

Formation of West Coast Branch.

ASIAN WOMEN’S WELFARE ASSOCIATION (AWWA)

• Formed by volunteer ladies to provide social services for

disadvantaged families in 1970 (Family Service Centre)

• Started a Handicapped Children’s Playgroup for children

with multiple disabilities 1979

• Expanded programmes for children and elderly

• Teach Me programme to integrate physically disabled

children but no intellectual disability into mainstream

nursery schools and kindergartens 1991

ASSOCIATION FOR THE EDUCATIONALLY SUBNORMAL

• 1971 Started as a subcommittee of SARC for the less severely retarded children (mainly for mildly intellectually disabled children with IQ 50-70) : 2 classes at Lee Kong Chian Gardens School.

• 1976 AESN was formed, taking over a disused school to become Katong Special School.

• Subsequently, AESN started Chao Yang Special School at Clemenceau Avenue.

• 2000 Renamed as Association for Persons with Special Needs (APSN) : 3 special education schools, a junior school and a senior school for older children & adults.

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE

1979 Christian Outreach to the Handicapped formed by a

group pf parents & volunteers to provide and promote

a ministry of Christian love and social support to the

intellectually- and multiply-disabled persons and their

families. Today it runs educational and day activity

programmes for such adolscents and adults.

1982 Teacher Training in Special Education:

Certificate in Special Education (CISE), last intake in

January 2002.

Diploma in Special Education (DISE)

MARGARET DRIVE SPECIAL SCHOOL (MDSS)

• 1983 Early Intervention Programme for children under 3

years old was started in SARC (MINDS)

• Increased demands for EIPs by other agencies resulted

in merging of all EIPs and the Margaret Drive Special

School ( MDSS ) was set up in 1987 as a project of the

Singapore Council of Social Service, funded by the

Community Chest of Singapore.

• A new programme for the Multiply Handicapped was

also started, in addition to the EIP, at the MDSS.

FROM MDSS TO RAINBOW CENTRE

• 1988 National Council of Social Service (NCSS) started

a programme for language-delayed children, especially

autistic children at MDSS : STEP Programme

• STEP Programme: Structured Teaching for Exceptional

Pupils. Staff:Student ratio 1:1

• 1992 MDSS became independent from NCSS.

The Rainbow Centre was established as a charitable

organisation under the Charity Act, affiliated to NCSS

• 1995 Balestier Special School under Rainbow Centre.

• 1998 New purpose-built building

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE

• 1986 Bizlink Centre Singapore Ltd. (SCSS) to run employment programmes for people with disabilities: vocational assessment services, job placement, and a production workshop engaged in sub-contracting work

• 1991 Dyslexia Association of Singapore

• 1995 Down Syndrome Association

• 2001 Metta Buddhist Association started Metta School for children with mild learning difficulties, including those with mild ASD

• 2002 Presbyterian Community Services started Grace Orchard School to cater to children with mild learning difficulties and mild ASD from 6 to 18 years.

MILESTONES OF SPECIAL EDUCATION IN SINGAPORE

• 1992 Autistic Association of Singapore : Parent support network and a Starkid Programme for preschool children with ASD.

• 1998 AAS and NCSS started the Autism Youth Centre for older autistic children > 12 years old.

• 1997 Autism Resource Centre: Diagnostic assessment, information on ASD, Outreach service to children with ASD in mainstream schools, and training under WeCAN.

• Rainbow Centre: 1989 Structured Training for Exceptional Pupils (STEP) 2001 Preschool Integration Enhancement Programme for preschool educators (PRiEP)

ADVISORY COUNCIL ON THE DISABLED 1988

• Government became an equal partner with the National Council of Social Service in the funding & management of special education.

• Ministry of Education would provide financial support of up to a maximum of twice the cost of educating a primary school child, matched by a similar contribution from the Community Chest of Singapore

• Master plan to set aside land for all special schools to be purpose-built by 2010

• Programme for early identification and management of children with developmental and behavioural problems: Child Development Programmes

MINISTRY OF HEALTHMISSION STATEMENT

To promote good health and reduce illnesses

To ensure that Singaporeans have access to

good and affordable healthcare that is

appropriate to their needs

To pursue medical excellence

EARLY CHILDHOOD DEVELOPMENT PLAN OF ACTION

Statutes

• Singapore’s Employment Act

• The Children and Young Persons Act

• The Women’s Charter

• The Child Care Centre Act and The Child Care Centres

Regulations

• The Penal Code

• The Infectious Disease Act

EARLY CHILDHOOD DEVELOPMENT PLAN OF ACTION

• Accession to the United Nations Convention of the

Rights of the Child in 1995.

• Enhancement of Early Childhood Programmes

Child health services should remain a top priority in

the nation’s health policy and should be enhanced to

give all Singaporeans a good start in life

PRINCIPLES of CHILDHOOD PROGRAMMES

• Build on existing structures

• Are sustainable

• Encourage partnerships Professional bodies, consumer groups, schools, charities and voluntary welfare organisations, parent groups and associations

• Multidisciplinary and team-based care

• Vertical integration through formal and professional linkage between generalists and specialists Shared care programmes, GP empowerment programmes

• Horizontal integration Specialist public-private sector collaboration

PRINCIPLES of CHILDHOOD PROGRAMMES

• Integration between health, educational, community, social and legal services: Inter-Ministerial coordinating, steering, & monitoring committees.

• Evidence-based or following best practice guidelines• Have a quality framework and can be evaluated• Are flexible• Are replicable• Use information technology to connect and integrate• Practice informs policy and vice versa• Family-centred or family-focused• Delivered in community-based & primary care settings

ESTABLISHED and ENHANCED CHILDHOOD PROGRAMMES

• National Childhood Immunization Programme

• National Standards for Child Protection

• National Safety Council

• National Healthy Lifestyle Programme

• Trim-And-Fit (TAF) Programme

• Childhood Nutrition Programme

• Childhood Asthma Shared Care Programme

• Childhood Diabetic Care Programme

• National Birth Defects Registry and Genetic Services

ESTABLISHED and ENHANCED CHILDHOOD PROGRAMMES

• Universal Neonatal Hearing Screening Programme

• National Myopia Prevention Programme

• School and Community Dental Health Service

• Childhood Cancer Shared Care Programme

• Childhood Cardiac Care Programme

• Childhood Chronic Renal Care Programme

• Mental Health and Good Parenting Programme

• Child Development Programme

CHILD DEVELOPMENT UNIT KK WOMEN’S & CHILDREN’S HOSPITAL

DEVELOPMENT ASSESSMENT CLINIC

Singapore General Hospital 1991Advisory Council on the

Disabled 1989

NEONATAL FOLLOW-UP CLINIC

Kandang Kerbau Hospital 1993

CHILD DEVELOPMENT UNIT KK WOMEN’S & CHILDREN’S

HOSPITAL 1997

CHILD DEVELOPMENT PROGRAMME

Early identification and treatment of children with

developmental and behavioural problems and disabilities

so as to:

• correct developmental dysfunctions;

• minimise the impact of a child’s disability or of prevailing

risk factors;

• strengthen families, and

• establish the foundations for subsequent development.

CHILD DEVELOPMENT PROGRAMME

Minister for Health

Inter-Ministerial CommitteeHealth, Education, Community Development

Overall policy directions & funding, Service guidelines & Coordination, and Professional standards

Director, Child Development Programme

Child Development Centre Western Cluster

National Healthcare Group

Child Development UnitEastern Cluster

Singapore Health Services

CHILD DEVELOPMENT SERVICE

Assessmentand ManagementPlanning

Hospitals (“At risk” Register), Polyclinics, Family doctorsPrivate Paediatric SpecialistsChild Care CentresPreschools and Primary schoolsParental Participation

Child Development Unit / CentreHospital-based, Multidisciplinary

Detection and Screening

SCREENING vs ASSESSMENT

Developmental Screening Developmental screening is aimed at providing pre-symptomatic detection of disability by examining apparently healthy children serially to determine whether they are developing normally

Developmental Assessment Developmental assessment is carried out on a child discovered by developmental screening to have developmental delays or behavioural disorders, to establish whether is a problem and, if so, the types and causes, followed by planned management of the child and the family

MULTI-DISCIPLINARY ASSESSMENT TEAM

• Paediatrician: neonatologist, developmental specialist

• Nurse / Coordinator

• Child psychologist / psychometrist

• Occupational and physical therapist

• Audiologist and speech and language therapist

• Ophthalmologist and otolaryngologist

• Medical social worker

• Other specialists : neurologist, endocrinologist, nutritionist, geneticist, paediatric surgeon, neurosurgeon, plastic surgeon, orthopaedic surgeon, dental surgeon…..

• Others: education counsellor, statistician, epidemiologist…

CHILD DEVELOPMENT SERVICE

Child Development Unit / CentreAssessment and Management Planning

Special SchoolsEarly Intervention Programmes

Special Education Schools Placement

Mainstream Schools

NurseriesKindergartens

Early Interventionsand Therapies at Polyclinics and Preschools

Social & Community SupportsLiaison with Schools and Pre-Schools

20% 80%

SOCIAL and COMMUNITY SUPPORTS

• Ministry of Community Development

• National Council of Social Service / Community Chest

• Voluntary Welfare Organizations, e.g., Singapore Children’s Society

Special Schools: MINDS, APSN, AWWA, Rainbow Centre, Spastic Children’s Association, Schools for the Visual & Hearting Impaired. Children’s Charities Association Club Rainbow Religious & Inter-racial self-help groups (CDAC, Mendaki, SINDA)

• Parents Support Groups: Autistic Association of Singapore, Autistic Resource Centre, Down Syndrome

Association, Dyslexia Association

SOCIAL and COMMUNITY SUPPORTS

• Healthy Start Programme for high-risk families

• Foster Care Services

• Fairy Godparents Programme

• Family Service Centres

• Programme for Special Needs Children in Pre-Schools

• Tinkle Friends Helplines

• Kidzgrow on-line Programme

• Project SEEDS

• School Cabin Projects

• Student Care Centres

• Children’s Residential care

EDUCATIONAL SUPPORTS

• Training of special education teachers, psychologists, and therapists.

• Training of teachers in mainstream pre-schools and schools in early identification and basic management skills of children with developmental problems.

• Health Education coursebooks.

• Learning Support Programme (LSP)

• Encouraging Achievement & Better Learning (ENABLE)

• Lifeskills Programme

• Psychological and Guidance Services

• Programme for School Children with Dyslexia

CHILD DEVELOPMENT AND REHABILITATION NETWORK

IN SINGAPORE

CHILD DEVELOPMENT UNIT

Primary Health Professionals

Special Education Agencies, Societies

SchoolsConsumer

Groups and Media

International and Regional Liaison&

Collaboration

Outreach Education Programmes for Public

and Parents