There has been a growing international demand for the inclusion

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1 CONNECTION BETWEEN INCLUSION AND HEALTH Vianne Timmons & Maryam Wagner National Inclusion Research Team A Report from the research of the National Inclusion Research Team: Kim Critchely (UPEI), Robert Dore (UQAM), Anne Jordan (U of T), Judy Lupart (U of A), Zana Lutfiyya (U of M), Roger Slee (U of London), Vianne Timmons (UPEI) & Community Partners: Canadian Teachers Federation, Centre for Research and Education in Human Services, Roeher Institute and the Canadian Association for Community Living. Funded by the Canadian Council of Learning. There has been a growing international demand for the inclusion of children with special needs into all levels of mainstream education, particularly over the past decade (Gray, 2005; Molto, 2003; Stahmer, Carter, Baker, & Miwa, 2003; Vlachou, 2004). Educators, administrators, policy makers and parents alike have taken stances in the debate over whether or not inclusion positively influences students. While inclusion is not a panacea for the issues children with disabilities face, and some individuals still benefit from specialized educational settings (Gray), there exists a connection between inclusion and health in that there are overall health benefits for children involved in inclusive education. Inclusive education is a national priority in today s society as demonstrated by the Speech from the Throne, February 2 nd, 2004: We want a Canada in which citizens with disabilities have the opportunity to contribute to and benefit from Canada s prosperity as learners, workers, volunteers and family members. Although this statement was a past government s commitment, national organizations continue to embrace similar beliefs. The conference press release of the Canadian Teachers Federation National Symposium on Inclusive Education in 2005 states: The mandate of publicly funded schools is to serve all children, regardless of their cultural, social, economic and linguistic backgrounds. The President of the Canadian Teachers Federation stated: When children learn and grow in inclusive schools, they learn to celebrate the rich diversity of our society. Today, teachers are faced with larger and more diverse classes of students. This increasingly diverse nature of classrooms presents many challenges as well as opportunities as we strive to create more inclusive schools. Special education is thus seen as a policy for placement and program allocation, rather than as a process for preventing underachievement and promoting the health and well-being of the whole student. The Health Canada report entitled The Critical Role of School Culture in Student Success (DeWitt, M c Kee, Fjeld, & Karioja, 2003) recommends that school staff improve students sense of belonging to their school, for example, by increasing student participation in school activities and through greater recognition of talents and skills. Prevention, rather than remediation requires a paradigm shift in school practices. Parental participation in schools and schooling are also positively related to student well being and sense of belonging. The report further recommends that academic standards should remain high, and that schools should provide appropriate supports to students: including more relevant assignments, more individual tutoring by teachers, more skills training for parents and peers, and more cooperative learning opportunities with peers without disabilities. The Canadian Council of Learning funded a group of national researchers to conduct a data analysis of the children s component of Statistics Canada s 2001 Participation and Activity Limitation Survey (PALS). PALS is Statistics Canada s flagship survey on persons with disabilities in Canada and is designed as a followup to the Canadian Census of Population (i.e. it is a post-censal disability survey). Both an adult and a children s component to PALS exists which provide a variety of information about people with disabilities in Canada. This information includes general details about the child such as age, schooling, family life, and socio-economic status, as well as disability specific information such as type of disability (e.g., learning, developmental, and psychological), and the severity of the child s disability (Statistics Canada, 2002). PALS provides information on the impact of the child s disability on her or his activities as well as the limitations or barriers experienced within education, transportation, and leisure activities. The purpose of analyzing PALS was to test the hypothesis that where educational services are organized to ensure inclusion, parents are more likely to report that their children are in good general health and that their children are doing well in school. PALS provided survey results for an estimated school aged children (aged 5 to 14 years) with disabilities. The analysis will be used to inform teachers, administrators, and parents of effective inclusionary practices. Although the primary focus of the results of this research will be knowledge exchange concerning inclusion of the group of students designated as having intellectual disabilities, the insight gained will provide the basis for later expansion to effective inclusion of a variety of learners and the prevention of learning and health-related difficulties in heterogeneous classrooms. The PALS questionnaire contains over 200 variables which address multiple facets concerning children with disabilities (Statistics Canada, 2002). Therefore, specific variables had to be identified that, when examined together, would best reflect a robust approach to inclusion. Robust approaches to inclusion are defined as ones that ensure that arrangements exist where all learners: 3

2 are welcome and included, in all their diversity and exceptionalities, in the regular classroom in the neighbourhood school with their age peers; are able to participate and develop to the fullest of their potential; and are involved in social valued relationships with diverse peers and adults. (Crawford, 2004) In order to simplify the data analysis and provide meaningful results, an inclusion scale was created from the survey responses that provided a direct measure of the level of inclusivity of the child. This scale was divided into a three-point scale reflecting three degrees of inclusivity, which were labelled low-inclusion, mid-inclusion, and high-inclusion. Table 1: Distribution of children with disabilities across the Inclusion Scale, by Province Inclusion Scale - 3 Groups (Low, Middle, High) Province Low Middle High % of Total at School* Newfoundland/ 29.7% 33.9% 36.4% 1.6% Labrador Prince Edward Island 17.1% 32.9% 50.0% 0.5% Nova Scotia 29.1% 27.1% 44.0% 3.5% New Brunswick 24.0% 24.8% 51.5% 2.5% Quebec 39.2% 26.9% 34.0% 14.2% Ontario 33.5% 35.3% 31.2% 45.0% Manitoba 31.1% 36.8% 32.1% 4.2% Saskatchewan 30.1% 35.7% 34.2% 3.0% Alberta 32.8% 36.1% 31.2% 12.5% British Columbia 32.0% 33.5% 34.5% 12.9% Total Percent 33.3% 33.3% 33.3% 100% Total Number 48,250 48,490 48, ,960 * Total is the percentage of the total population of students in Canada within the province. The analysis of the data provided exciting results to the National Research Team. The results revealed that there is an association between parents perception of health of their children and the level of inclusivity of the children. In broad terms, the study of PALS revealed an identifiable trend wherein children with disabilities who are highly included are in better general health overall (as reported by their parents). While inclusion is not a panacea for the issues children with disabilities face, and some individuals still benefit from specialized educational settings (Gray, 2005), there exists a connection between inclusion and health in that there are overall health benefits for children involved in inclusive education. This Canadian research supports Gray s work. Chart 1: General Health, By Inclusion Scale 4

3 This research examined the relationship between inclusion and health in Canada, as well as within each province. Table 1 reflects the level of inclusion in each province as revealed through the analysis of PALS survey responses. High levels of inclusion are reported in Prince Edward Island, Nova Scotia and New Brunswick. Looking at parents perceptions of their children s health revealed that when a child was in a more robust inclusive setting, her/his health was better. This trend can be observed in Chart 1. As evident in this chart, 76.3% of parents reported their children s health as excellent in high levels of inclusion, compared to 55.7% of parents whose children were in less inclusive settings. Educators may question this result hypothesizing that children who are healthier are placed in more inclusive settings. The research team examined this hypothesis in more depth by looking at this same relationship while considering the degree of disability of the child. As illustrated in Chart 2, regardless of severity of disability, parents report better heath of children who are placed in high inclusive settings. As many children with disabilities are unable to report on their own health, parents are the best proxies for the children. They know their children s health status as they live with them and are the ones who interface with the medical community. It is not a teacher s job to serve as a nurse or a doctor for children; a teacher s job is to educate children. Do children with special needs perform better academically in inclusive settings? Parents were asked this very important question....inclusive CLASSROOMS HAVE THE POSITIVE EFFECT OF PROMOTING HEALTHY SOCIAL RELATIONSHIPS BETWEEN CHILDREN WITH SPECIAL NEEDS AND THE REST OF SOCIETY. STUDENTS WHO ARE REGULARLY EXPOSED TO CHILDREN WITH SPECIAL NEEDS AS THEIR EQUAL COUNTERPARTS GAIN UNDERSTANDING AND EMPATHY FOR HUMAN DIFFERENCE... Chart 3 illustrates that more parents (52%) feel that their children with special needs do better in inclusive settings. Only 15.8% of parents feel that their children do poorly compared to 40.5% of parents of children in low inclusive settings. Willms (2002) states, it is not inclusion alone that impacts achievement. The specific stream and school program in which students are placed, and the quality of the instruction received are highly influential on the success of students (Looker & Thiessen, 2004; Wayne & Youngs, 2003). Related to these factors is the situation that special education is delivered only once a student has Chart 2: Student Health by Degree of Disability and Inclusion Scale 5

4 Chart 3: Progress at School by Inclusion Scale been designated as belonging to a category of disability rather than prior to designation. Less attention is thus given to preventing the assignment of students into special education, since they become eligible for special education support only after designation. Withdrawal and segregated settings for specialized help raise further barriers to participation in the educational mainstream. Special education often represents a one-way path out of the academic mainstream. While there is lip service to inclusion and to re-integration, in practice, the onus is on students to demonstrate that they have become eligible for reintegration. Another area of importance for parents is the relationship children with special needs have with peers. This research also explored the connection between inclusive setting and peer relationships. Are a child s relationships with peers influenced by her/his level of inclusivity? Parents (72.6%) felt that their children interacted very well with other children when placed in highly inclusive settings, compared to less than half of the parents whose children were in less robust inclusive settings. A teacher is responsible for preparing children to live in a diverse world with people of different religions, races, cultures and abilities. This important goal can be accomplished if the classrooms in which students are educated are diverse and rich with unique children. For children with special needs, the successful inclusive classroom offers an environment where these children can interact with all their peers, not just the special needs peers they would interact with in specialized settings. Through inclusion, students with special needs can further develop their social skills and their ability to interact with people their own age. As Heiman (2000) notes, students with intellectual disabilities have more friends in Chart 4: Interaction with Other Children, by Inclusion Scale 6

5 inclusive schools than they do in special needs schools, and social connections between students and their peers enrich their private world by providing emotional support, offering means of relaxation and providing opportunities to voice various frustrations (p. 1). Inclusive classrooms allow students with special needs to form larger social networks, which positively influence an individual s future and indicate better social adjustment throughout life (Heiman; Knox & Hickson, 2001). To ensure these social connections inclusive education cannot be just a placement, but rather a process where teachers and students work together to ensure an inclusive classroom climate. Individuals who are socially adjusted have a greater chance of maintaining lasting, fulfilling relationships, which in turn leads to a healthier overall life. Inclusive classrooms also have the positive effect of promoting healthy social relationships between children with special needs and the rest of society. Students who are regularly exposed to children with special needs as their equal counterparts gain understanding and empathy for human difference (Graves & Tracy, 1998; Gray, 2005). Therefore, students in inclusive classrooms learn advanced social skills such as how to get along with others, are more receptive and helpful to others, and exhibit less prejudice and stereotyping (Stahmer et al., 2003). These benefits accumulate to help create a more pluralistic society, which celebrates rather than condemns the diversity of individual differences. It is, however, important to acknowledge that the benefits of inclusion depend largely on the predisposition of school administrators, teachers, and parents to facilitate the necessary adjustments for children with special needs to succeed in the mainstream classroom (Dugger-Wadsworth & Knight, 1999; Molto, 2003). School administrators, teachers, and parents will benefit from having the opportunity to access evidence that supports their efforts at inclusion. As Graves and Tracy (1998) eloquently state: more can be learnt [sic] from one successful inclusion than from a string of failures...with a positive commitment, inclusion is possible (p. 222). One could easily argue that more can be gained from the same success. Given the health benefits that accompany it, successful inclusion appears to be an important constituent to mutually improving the lives of children with and without special needs. How can this research inform practice? There is little national research on the impact of inclusive practice and this work fills this gap. It is national in scope, looking at large numbers of children. It clearly identifies an association between inclusive practices and positive health, social and academic outcomes. As a teacher, it can be challenging to teach a classroom of students with diverse abilities; however this research indicates that the challenge can produce positive results for children and their families. Teachers in Canada are leaders in inclusive practice, and this research is an affirmation of the positive impacts that are being experienced by children with disabilities. Teachers make a difference in the lives of children and families, and positively impact their health. About the Authors Vianne Timmons is the Vice-President Academic Development at the University of Prince Edward Island in Canada and president elect at the University of Regina. She has served as Dean of Education at the University of Prince Edward Island and chair for the Department of Education at St. Francis Xavier University. She was formerly editor of the journal, Exceptionality Education Canada, Dr. Timmons is also a member of the National Centre of Excellence, Language and Literacy, is the lead education trainer for the National Resource Centre for Inclusion-India funded by CIDA, and is an officer and board member of the International Association for the Scientific Study of Intellectual Disabilities. Her present research focuses on family literacy in rural communities, aboriginal children, inclusion of children with special needs, and knowledge exchange. Dr. Timmons conducts workshops for teaching and presents her work nationally and internationally. Maryam Wagner is a research coordinator and instructor of English for Academic Preparation at the University of Prince Edward Island. She has many years of experience in research in multiple fields including international education, family literacy, and inclusion. She holds Bachelor degrees in Chemistry and in Education. In May 2008, she graduated with her Master of Education degree from the University of Prince Edward Island. References...STUDENTS IN INCLUSIVE CLASSROOMS LEARN ADVANCED SOCIAL SKILLS SUCH AS HOW TO GET ALONG WITH OTHERS, ARE MORE RECEPTIVE AND HELPFUL TO OTHERS, AND EXHIBIT LESS PREJUDICE AND STEREOTYPING... Crawford, C. (2004). Supporting teachers: A foundation for advancing inclusive education. Toronto: Roeher Institute. DeWitt, D., M c Kee, C., Fjeld, J., & Karioja, K. (2003). The critical role of school culture in student success. Health Canada. Dugger-Wadsworth, D.E. & Knight, D. (1999). Preparing the inclusion classroom for students with special physical and health needs. Intervention in School & Clinic, 34(3), Graves, P., & Tracy, J. (1998). Education for children with disabilities: The rationale for inclusion. Journal of Paediatrics & Child Health, 34(3),

6 Gray, C. (2005). Inclusion, impact and need: Young children with a visual impairment. Child Care in Practice, 11(2), Heiman, T. (2000). Friendship quality among children in three educational settings. Journal of Intellectual & Development Disability, 25(1), Knox, M., & Hickson, F. (2001). The meanings of close friendship: The views of four people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 14, Looker, D., & Thiessen, V. (2004). Aspirations of Canadian Youth for Higher Education. Final report: Learning resources Directorate, Human Resources and Skills development Canada. Retrieved Oct 27 th 2005 at /en/cs/sp/hrsdc/lp/publications Molto, M.C.C. (2003). Mainstream teachers acceptance of instructional adaptations in Spain. European Journal of Special Needs Education, 18(3), Stahmer, A.C., Carter, C., Baker, M., & Miwa, K. (2003). Parent perspective on their toddlers development: Comparison of regular and inclusion childcare. Early Child Development & Care, 173(5), Statistics Canada (2002). A new approach to disability data: Changes between the 1991 Health and Activity Limitation Survey (HALS) and the 2001 Participation and Activity Limitation Survey (PALS). (Government of Canada of Canada Publication No XIE). Ottawa, ON: Author. Vlachou, A. (2004). Education and inclusive policy-making: Implications for research and practice. International Journal of Inclusive Education, 8(1), Wayne, A. J., & Youngs, P. (2003). Teacher characteristics and student achievement gains: A review. Review of Educational Research, 73,(1), Willms, J. D. (2002a). Vulnerable Children. The University of Alberta Press: Edmonton, AB SUBMIT AN ARTICLE TO HEALTH & LEARNING MAGAZINE: Do you have something to say about school health? We encourage submissions from our readers. Please send your article (under 3,000 words) to nohai@ctf-fce.ca for consideration. Articles may be edited for style and clarity. Minimum resolution for accompanying photos is 300 dpi. 8