Photo: Ability Bhutan Society

Sore requirement of paraprofessionals and therapists in inclusive schools in the country

To bring the changes in the lives of children in special education, para-professionals are required, says a physiotherapist and also an occupational therapist.

A SEN coordinator of the Tendruk Central School in Samtse, Tara Devi said children with Cerebral Palsy (CP) with various fine motors and gross motors needs a paraprofessional since these children need regular therapy.

Parents are taught with this therapy, but they do not apply to their child as some parents say they are busy and some are busy with work leading to no improvement in their child’s gross motor skills, she said.

She expressed that it should be at a policy level and if the policy is in place, the curriculum will definitely get all these para-professionals. It is there in the National Disability policy and endorsed but it has failed in implementation, she added.

The Bhutanese interviewed a physiotherapist and an occupational therapist and both of them said paraprofessionals in inclusive schools are required in order to bring changes in an individual child.

Pasang Dorji, a Physiotherapist in the Samtse Hospital and currently in KGUMSB has been providing physiotherapy to the children with disabilities in Tendruk Central School and he personally shares that he has not been able to provide services fully due to limited days and two times is not enough.

He said the school has around 70 children and he spent around 2 hours with children and most of the time they teach their parents how to provide therapy at home. There are some children who cannot read and write, so he also teaches them how to communicate through non-verbal means.

He shared that having had limited physiotherapists in the country, taking services at the community level is quite challenging. Generally people think that a physiotherapist’s job is similar to massage therapists but physiotherapists can work in all walks of life and are especially required in the community since the larger section of people with various disabilities are in the rural parts.

However, a single physiotherapist cannot provide better services to the people with disabilities, as it requires collaboration from various agencies including the parents.

As per his experiences, he said it is high time for inclusive schools to have one nurse or enough trained SEN teachers so that they can handle the children with various disabilities in the schools or have at least one physiotherapist or make it available in their community.

One of the challenges is that most of the parents do not have health literacy and so discrimination which he says it begins from home itself. He said it takes a lot of time to convince them and sometimes it does not work either. So it is important to create awareness with regard to health literacy. “We are also at fault because we have to advocate for them on health education but we don’t have time,” he added.

Similarly, an Occupational Therapist (OT) is also in need in the SEN schools to be impactful and wants to make a difference in the children with disabilities. There is a need for a regular professional who will cater to the everyday issue of a child.

Dechen Tshomo, an Occupational Therapist (OT) at Jigme Dorji Wangchuck National Referral Hospital said having Occupational Therapist in inclusive schools would be nothing new as many of the special schools abroad have OTs to cater to the wide range of disabilities population at the school.

The special schools must have at least one OT as meeting the needs of the special children is beyond what the teachers and infrastructure could provide. Occupational therapists have a broad understanding of how illness, injury, or developmental disabilities affect participation and ways to address physical, cognitive, sensory, and psychosocial challenges and they have expertise in task analysis, adapting tasks to match an individual’s skills, assistive technology and modifying the environment to enable participation. This professional background makes occupational therapy practitioners well suited to help create universal as well as individualized supports and accommodations for students with disabilities that support access, participation, and success in the school settings, she said.

She used to visit a SEN school in Thimphu monthly and was a part of PP admission for special children, but now with the increasing number of cases in the hospital, the visits to the school are not that frequent.

She currently accepts the referral for OT services from schools and has enrolled a few students for regular OT sessions. She said that the intervention should be carried over to the schools from the early interventions services as the children with the disability require the interventions throughout to meet challenges of the day to day activities and therefore an occasional visits by OTs to the schools can barely make the impact.

The education ministry has been more successful in catering to children with physical disabilities but not much to those with invisible disabilities who require more attention and care. School occupational therapists can be key contributors within the education team. OT can support a student’s ability to participate in desired daily school activities or “occupations.” They can work to help children to fulfill their role as students by supporting their academic achievement and promoting positive behaviors necessary for learning.

Because of their expertise in activity and environmental analysis, OTs are particularly skilled in facilitating student access to curricular and extracurricular activities. They can focus on the students’ strengths, and can help to design and implement programming to improve inclusion and accessibility.

Additionally, they can play a critical role in educating parents, educators, administrators and other staff members. They can offer services along a continuum of prevention, promotion, and interventions and serve individual students, groups of students, whole classrooms, and whole school initiatives and collaborate within the education team to support student success.

Currently with only three occupational therapists in the country reaching services to the schools is challenging as the services are available by various disability populations with both physical and mental challenges of various age groups apart from the children with disabilities. As the profession is new to the country and the services are still in the process of establishing the services are only hospital based.

Meanwhile, the Education Minister Jai Bir Rai said Paro College will be providing sub-specialization in ECCD and Sub-specialization in SEN where they will be trained for paraprofessionals after completing a four years course.

All the programs are planned and ready to be implemented.

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