1. Collaboration between Health and Educational
Systems to Improve the Inclusion of Children with
Special Needs in Schools
First International Developmental Pediatrics Congress
December 2-5, 2015
Sabanci Center, 4. Levent, Istanbul, Turkey
Olaf Kraus de Camargo, MD, PhD; Nezihe Elik, PhD;
Heidi M. Feldman, MD, PhD; Z. Hande Sart, PhD
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2. Prologue
“Disability is a difficulty in functioning at the
body, person, or societal levels, in one or
more life domains, as experiences by an
individual with a health condition in interaction
with contextual factors” (Leonardi et al., 2006)
“The test of the morality of a society is what it
does for its children” (Dietrich Bonhoeffer,
1906 - 1945)
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3. Outline
• The United Nations Convention on the Rights of
Persons with Disabilities
• Practice of Inclusion in Canada
• Current Challenges in Canada
• Practice of Inclusion in Turkey
• Current Challenges in Turkey
• Lessons Learned from Canada, Turkey, and the
U.S.A. and our Vision
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4. Convention on the Rights of Persons with
Disabilities (adopted 2006)
Art 24.2: In realizing this right, States Parties shall ensure that:
a) Persons with disabilities are not excluded from the general education system on
the basis of disability, and that children with disabilities are not excluded from free
and compulsory primary education, or from secondary education, on the basis of
disability;
b) Persons with disabilities can access an inclusive, quality and free primary
education and secondary education on an equal basis with others in the
communities in which they live;
c) Reasonable accommodation of the individual’s requirements is provided;
d) Persons with disabilities receive the support required, within the general
education system, to facilitate their effective education;
e) Effective individualized support measures are provided in environments that
maximize academic and social development, consistent with the goal of full
inclusion.
http://www.un.org/disabilities/convention/conventionfull.shtml
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5. Convention on the Rights of Persons with
Disabilities
Convention and the Optional Protocol: signing the protocol means
that the state parties agree to be examined by a UN committee if
concerns about the implementation of the convention arise.
Canada:
• signed convention in 30-03-2007, ratified convention in 11-03-
2010,
• did not sign or ratify the optional protocol
Turkey:
• signed convention in 30-03-2007, ratified convention in 28-09-
2009,
• signed the optional protocol in 28-09-2009, ratified the protocol in
26-03-2015
United States of America:
• signed convention in 30-07-2009, did not ratify the convention
• did not sign or ratify the optional protocol
http://www.un.org/disabilities/countries.asp?navid=17&pid=1665

6. Inclusion in Canada (Ontario)
• The Education Act requires school boards to provide in accordance with
the regulations special education programs and special education services
for its exceptional pupils. Specific procedures for the identification and
placement of exceptional pupils are set out in Regulation 181/98.
(www.edu.gov.on.ca/eng/).
• Various associations (e.g., www.ldao.ca) advocate for children with
disabilities and special needs.
• Example: A supreme court ruling on a case (2013) supported the rights of
people for special education in the public education system, and decided
that schools cannot ask students to go to a private special school
because they have severe needs (http://www.ldao.ca/educational-
implications-of-recent-supreme-court-ruling/).
• Inclusion of students in education system requires flexibility because
children with disabilities have diverse needs. Schools should have special
education services, with the goal to integrate the child into regular
education classrooms for all or part of the curriculum.
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7. Challenges in Canada
• discontinuity of services between home
and school environment
• diagnosis and IQ-based access to services
creates tension between clinic and school
• personal supports (educational assistants)
driven by potential of liability instead of
needs
(e.g., Philpott, 2007)
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8. “in-between-the-chairs”
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9. Overcoming Challenges in Canada
• consultation from developmental pediatricians and psychologists to schools
directly and indirectly (team members go to schools): advocating for child’s needs
by explaining the needs (not necessarily diagnosis) to parents and teachers
• working with the team members (therapists) who go to home and school settings to
implement interventions
• empowering parents and making them more active in collaborating with school
and in utilizing community resources
• providing assessments and recommendations to be utilized at home and at
school, with continued follow up
• intervention research studies that aim at supporting teachers in classrooms (e.g.
Teacher Help for ADHD (http://www.researchgate.net/publication/281713389_Web-
Based_Intervention_for_Teachers_of_Elementary_Students_With_ADHD, CanChild - https://www.canchild.ca)
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10. Inclusion in Turkey
• the policies are similar to Canadian educational act, with a
slightly different language in that the inclusion practices in regular
classrooms are described as “desirable” but there are items that
indicate that if this is not possible then the child could be deemed
not possible to receive education in a regular classroom, rather,
they would need to be in a special education classroom or special
education school, or even at home (e.g., Item 27)
(http://mevzuat.meb.gov.tr/html/26184_0.html)
• although collaboration with other professionals (outside of the
school) are mentioned, it appears that special education teachers
and guidance counselors are the main consultants to teachers
• medical and educational diagnoses for eligibility for “treatment” in
schools
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11. Challenges in Turkey
• special education classrooms and schools are
utilized and preferred by parents more widely
than ideal (Sakiz et al., 2015)
• guidance counselors’ educational background
• studies show negative attitudes and limited
knowledge toward inclusion of children with
disabilities (Bayram et al., 2015)
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12. Overcoming Challenges in Turkey
• there has been an initiative to support inclusion practices:
http://gazetesu.sabanciuniv.edu/sites/gazetesu.sabanciuniv.e
du/files/engellilikraporu.02.04.13.pdf
• researchers are documenting the need for supporting
regular education teachers (in terms of their knowledge,
attitudes, materials, family engagement) to include children
with special needs (Sakiz, 2014)
• developing In-service Training for Inclusive Classroom
Practices (DISTINC) is a European Union project;
http://distinc.org
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13. Lessons Learned
Collaborative team approach within the hospital, but also by including
teachers, parents and home-based therapists in helping the child (it
takes a village to raise a child)
Family-centred approaches and overcoming barriers for both parents
and teachers by increased communication of these barriers
Specialists and diagnosticians have to relay their knowledge of the
child and recommendations in person, not only through a report
Increased early assessment services will set the child in the right
track and early intervention will be more effective (response to
intervention)
Increased communication between researchers, clinicians, and
school staff to have interventions done by researchers (to overcome
budget cuts)
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14. Vision for the Future
System level: legislation to ensure that services are
provided based on needs (International Classification of
Functioning, Disability and Health, WHO) – See
“Redesigning Healthcare for Children with Disabilities” by
Heidi M. Feldman
International collaboration and knowledge translation
Clinical and School Level: Collaborative approach with
participation of all persons involved with the child,
listening to the persons with disabilities
(http://machealth.ca/programs/curriculum_of_caring/m)
Desired Outcome: A supportive and individualized
approach to learning and development for all children,
based on their needs, leading to full inclusion.
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15. Biopsychosocial Model
Religious
groups
Bronfenbrenner
(1979)
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16. Collaborative Approaches
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17. Epilogue
“If you treat an individual as he is, he
will remain how he is. But if you treat
him as if he were what he ought to be
and could be, he will become what he
ought to be and could be. (Johann
Wolfgang von Goethe)
“Kids do well if they can” (Green,
2014)
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18. References
• Bayram, G. I., Corlu, M. S., Aydin, E., Ortactepe, D., & Alapala, B. (2015). An exploratory study
of visually impaired students' perceptions of inclusive mathematics education. British Journal of
Visual Impairment, 33(3), 212-219. doi: 10.1177/0264619615591865.
• Green, R. (2014). Lost at school: Why our kids with behavioral challenges are falling through the
cracks and how we can help them. New York, NY: Scribner.
• Leonardi, M., Bickenbach, J., Ustun, T. B., Kostanjsek, N., Chatterji, S., & Consortium, M.
(2006). The definition of disability: what is in a name? Lancet, 368(9543), 1219–1221.
http://doi.org/10.1016/S0140-6736(06)69498-1
• Philpott, D. F. (2007). Assessing without labels: Culturally defined inclusive education.
Exceptionality Education Canada, 17(3), 3-34. Retrieved from
http://search.proquest.com/docview/622140457?accountid=12347
• Sakiz, H., Sart, Z. H., Borkan, B., Korkmaz, B., & Babur, N. (2015). Quality of life of children with
learning disabilities: A comparison of self-reports and proxy reports. Learning Disabilities
Research & Practice, 30(3), 114-126.
• Sakız, H. & Woods, C. (2014). From thinking to practice: school staff views on disability
inclusion in Turkey. European Journal of Special Needs Education, 29(2), 135-152.
doi:10.1080/08856257.2014.882058.
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19. Thank you!
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