integration of a disabled child into a childcare facility ......integration of a disabled child into...

FO-5035A (05-2017)

Ministère de la Famille

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Integration of a disabled child into a childcare facility

The development of an integration plan and its periodic or annual review aim to determine—as objectively as possible—the child’s actual needs in terms of integration based on the childcare provider’s activities, the layout of the premises and the availability of equipment.

Developed by the childcare provider and the child’s parents or guardians, the integration plan must specify the needs for material and human resources required according to the recommendations of various professionals recognized by the Ministère de la Famille (the Ministère1).

It is possible that the childcare provider will not implement all the recommendations of the professional(s) consulted. In this case, the childcare provider and the parents must indicate in an appendix why the recommended resources do not all appear in the integration plan.

The plan must be reviewed and enhanced as needed, at least once a year. The date and signature of the updated integration plan confirm the periodic or annual update.

The integration plan is comprised of four parts:

Part A General information;

Part B Evaluation of the child’s abillities;

Part C Identification of the child’s special needs and potential means to meet them;

Part D Identification of the childcare provider’s needs to meet the child’s special needs.

• Parts A and B must be completed by the parents. They can consult the childcare provider for Part B.

• The information provided in this document will remain strictly confidential.

In addition to this document, the following documents must be placed in the parental record:

• The Board of Directors resolution in view of integrating a disabled child into a childcare facility, as applicable;

• A certificate from Retraite Québec or a report by a professional recognized by the Ministère, attesting the child’s disabilities;

• A document presenting the recommendations of at least one professional pertaining to the measures to apply, particularly with respect to material and human resources. These recommendations can be formulated by the professional who has attested the child’s disabilities or other professionals recognized by the Ministère;

• Invoices and other vouchers related to the use of Part A of the allowance;

• Reasons for refusal of integration as they are specified in the integration or expulsion policy of the childcare provider, as applicable.

1. The list of professionals who can sign this report is available in the Professional’s Report form on the Ministère’s website.

Integration Plan – Document to retain in the parental record

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Part A General informationChild identification

Child’s last name and first name

Address (number, street, apt.)

City Province Postal code

Date of birth (YYYY-MM-DD) Current age Telephone

Identification of the parents or guardian

Parent’s last name and first name

Telephone ext. Email





Identification of the childcare provider

Childcare centre (CPE)

Home childcare provider (HCP) with subsidized places

Subsidized daycare centre

Name of the childcare provider

Address (number, street, apt.) Choose a region

Name of the home childcare Coordinating Office (CO), as applicable

Address (number, street, apt.) Choose a region

Licence capacity or number of children the HCP can accept based on its recognition

Number of spaces held by children with disabilities

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Last name and first name of contact person

Telephone ext. Position

Date child was admitted to the childcare facility

Date of declaration of disability (or of need for integration support)

Child’s experience in a childcare facility

Has the child ever attended a childcare facility? Yes No

Centre based childcare facility Home childcare

Does the child go to the nursery of a centre based childcare facility? Yes No

Services spécialisés

Has the child ever received specialized services (e.g., medical, adaptation and rehabilitation services)? Yes No

If yes, please provide the following information:

1. Organization or facility that provided the specialized services

Last name and first name of the professional

Profession Telephone ext.







If the child has received specialized services in the past but no longer receives them now, enter the date when the service ended

(YYYY-MM-DD)

(YYYY-MM-DD)

(YYYY-MM-DD)

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Technical aids

Does the child use technical aids or any other means to compensate for his or her disability or to help with certain everyday activities (e.g., hearing aids, prosthesis, orthosis, Bliss symbol, wheelchair, tricycle)?

Yes No

If yes, please specify:

Drugs and treatment

If yes, please specify:

Part B Evaluation of the child’s abilities

This section aims to provide the elements needed for analysis of the child’s special needs.

Daily activities

Here is a list of everyday activities:

Check the response that best describes the child’s usual ability to perform the activity. If the child does not have any difficulty performing the activity, or if the activity does not apply to his or her case, check “not applicable.”.

In order to monitor the child’s progress, check his or her current level of learning2.

Nutrition

Not applicable

With difficulty With technical aidWith

assistanceUnable of

performing Never learnedLearning

in progressLearning

completed

Eats (e.g., non-slip plate, adapted utensils)

Drinks (e.g., with a straw, from the cup)

Special diet:

Food consistency (e.g., puree):

Position during meals (e.g., bumping block, arm chair):

2. Note that this refers to specialized and non-specialized learning other than those associated with common activities for a child of that age.

1

2

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Dressing

Not applicable


assistanceUnable of


in progressLearning

completed

Removes his/her shoes

Puts on his/her shoes

Undresses him/herself

Dresses him/herself

Unfastens his/her clothes

Fastens his/her clothes

Comment:

Potty training

Not applicable

Wears diapers Occasionally Permanently


assistanceUnable of


in progressLearning

completed

Sits on the potty

Sits on the toilet

Asks to go

Washes his/her hands and face

Comment:

Intolerances or special sensitivities

Not applicable

To cold To the sun To wind To noise

To air To heat To dust Allergies (specify)

Comment:

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Gross motor skills

Not applicable


assistanceUnable of


in progressLearning

completed

Raises and bows his/her head

Rolls over, changes position

Crawls

Sits

Moves on all fours

Walks

Pushes or pulls a toy while walking

Runs

Joins in activities that require physical coordination (e.g., claps his/her hands, catches a ball, walks down the stairs)

Can do activities such as use a swing, a tricycle, a slide

Comment:

Coordination difficulties:

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Position to favour:

Position to avoid:

Fine motor skills

Not applicable


assistanceUnable of


in progressLearning

completed

Grasps an object with his/her hands

Handles an object

Transfers an object from one hand to the other and voluntarily releases the object

Grabs an object with his/her thumb and index finger

Empties and fills a container

Stacks rings on a pole

Stacks, makes a tower using three blocks

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assistanceUnable of


in progressLearning

completed

Turns the pages of a book

Rolls playdoh into a ball

Makes a puzzle

Screws, unscrews, turns a doorknob

Holds a pencil between his/her thumb and index

Uses scissors

Comment:

Verbal and non-verbal communication

Not applicable


assistanceUnable of


in progressLearning

completed

Notices sounds, messages, music

Mimics sounds

Understands and executes a simple instruction

Gives or points to objects on demand

Communicates using signs, gestures and sounds

Mimics noises, animal sounds, etc.

Expresses him/her-self using two words consecutively (e.g., Want this! )

Answers simple questions

Executes two instructions with a common thread

Speaks fluently

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Comment:

Vision

Not applicable

Wears glasses: Yes No


assistanceUnable of


in progressLearning

completed

Finds a hidden object

Follows the adult and other children with his/her eyes when they move around

Is attracted to his/her reflection in the mirror

Takes part in activities requiring fine vision (recognizes shapes, objects, colours, etc.)

Moves around without bumping into things or falling

Takes part in activities requiring distance and peripheral vision (ball, obstacle games)

Comment:

Reasoning

Not applicable


assistanceUnable of


in progressLearning

completed

Finds a hidden object (behind his/her back, under a bucket)

Copies simple gestures

Makes associations and places objects in a given order

Executes an instruction (Give, Take, Come, etc.)

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assistanceUnable of


in progressLearning

completed

Points to a picture or item mentioned

Matches three colours

Understands the notion of “the same and different”

Focuses during structured activities

Plays the same games as other children his/her age

Comment:

Adaptation and socialization

Not applicable


assistanceUnable of


in progressLearning

completed

Reacts to the adult’s presence

Tolerates his/her parent’s absence

Supports the educator’s absence

Responds when he/she is called upon

Mimics others’ gestures when playing (can imitate)

Furthers simple instructions

Plays with his/her peers

Can play alone

Stays in the yard or within an established perimeter

Communicates

Shares

Waits his/her turn

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assistanceUnable of


in progressLearning

completed

Avoids certain dangers

Engages in free play

Cooperates during play

Avoids actions that are dangerous to him/herself and to others

Comment:

Part C Identification of the child’s special needs and potential means to meet them“Special needs” refers to the needs directly linked to the impairment and disabilities, the other needs having been recognized as individual needs comparable to those of any other child.

Nutrition

Not applicable

Explain the difficulties encountered:

Specify the potential means to mitigate integration obstacles:

Dressing

Not applicable



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Potty training

Not applicable



Intolerances or special sensitivities, allergies

Not applicable



Gross motor skills

Not applicable



Fine motor skills

Not applicable



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Verbal and non-verbal communication

Not applicable



Vision

Not applicable



Reasoning

Not applicable



Adaptation and socialization

Not applicable



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Part D Identification of the childcare provider’s needs to meet the child’s special needsNote that the childcare provider must specify any material and human resources needed in accordance with the recommendations of the professionals recognized by the Ministère and with the analysis of the needs identified in Part C above.

Experience of the childcare provider

Has the staff already experienced the integration of a disabled child? Yes No

Needs in terms of:

Material resources

Adaptation of material or equipment used by children of the same age.

Specify:

Purchase of specialized equipment or material.

Specify:

Layout

Specify:

Human Resources

Reduced number of children per educator or HCP.

Specify:

Addition of staff or of an assistant.

Specify:

Training and replacement of staff who receive this training.

Specify:

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Others

Specify:

External collaboration and search for information

Professional support (rehabilitation centre, CISSS/CIUSSS, etc.)

Specify:

Information and documentation (e.g., type of disability, bibliography)

Specify:

Special training (e.g., using the device, special means of communication)

Specify:

SignaturesI agree with this integration plan for my child and undertake to collaborate with the childcare provider.

Date (YYYY-MM-DD) Signature of the parent or guardian

I undertake to immediately implement this integration plan and to update it as needed, no later than one year from today.

Date (YYYY-MM-DD) Signature of the person responsible for integration at the childcare facility

For more information

For more information, contact the Ministère’s Information Service at: 1 855 336-8568 or visit the Ministère’s website: www.mfa.gouv.qc.ca

X

X

http://www.mfa.gouv.qc.ca

Case d'option 1: OffVille 3: Ville 4: Ville 2: Province 2: Province 3: Date naissance 2: Age 2: Champ de texte 1011: Ville 5: Champ de texte 1026: Champ de texte 1024: Courriel 3: Ville 6: Champ de texte 1027: Champ de texte 1025: Courriel 4: Ville 7: Champ de texte 1029: Champ de texte 1028: Courriel 5: Ville 8: Ville 10: Liste déroulante 15: [Choose an option]Ville 9: Adresse 7: Liste déroulante 16: [Choose an option]Champs de texte 2016: Champs de texte 2015: Case d'option 2: OffCase d'option 3: OffCase d'option 4: OffCase d'option 5: OffVille 13: Champ de texte 1044: Champ de texte 1043: Courriel 6: Champs de texte 2022: Champs de texte 2023: organisme 3: nom prenom 10: profession 3: Champ de texte 1047: Champ de texte 1046: organisme 4: nom prenom 11: profession 4: Champ de texte 1049: Champ de texte 1048: organisme 5: nom prenom 12: profession 5: Champ de texte 1051: Champ de texte 1050: Champs de texte 2021: Case d'option 6: OffCase à cocher 8: OffCase d'option 7-1: OffCase 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Champ de texte 295: Case à cocher 6: OffCase à cocher 7: OffChamp de texte 296: Champ de texte 297: Champ de texte 298: Champ de texte 299: Ville 14: Ville 15:

integration of a disabled child into a childcare facility ......integration of a disabled child into...

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