Seizing the Chance of Early Intervention through Pre-school Rehabilitation Services

Together with a group of scholars across disciplines and institutions as well as experts from social welfare organisations, Dr Anna HUI, Associate Professor at the Department of Social and Behavioural Sciences (SS), College of Liberal Arts and Social Sciences, CityU, was appointed by the Hong Kong government to lead the research and consulting team for the pilot scheme on On-site Pre-school Rehabilitation Services. Other members include Dr Elaine AU (Associate Professor), Dr Sam YE (Associate Professor) and Dr CHEN Huifang (Assistant Professor) from the Department of Social and Behavioural Sciences; Dr Angela SIU, Associate Professor in the Department of Educational Psychology from the Chinese University of Hong Kong; Dr LEUNG Man-tak (Associate Professor in the Department of Chinese and Bilingual Studies) and Dr Andy CHENG (Associate Professor in the Department of Rehabilitation Sciences) from the Hong Kong Polytechnic University; and Dr HSIEH Wu-ying, Associate Professor in the College of Education, University of Northern Iowa. This undertaking represents a significant contribution and experience in university research serving the greater social community. Reports prepared by Dr Hui for the scheme also provide valuable suggestions for the improvement of future social services.

As a researcher and an educator at CityU, Dr Hui dedicates herself to early childhood education in Hong Kong. She developed a proposal with professionals and scholars from other institutions after the government invited local universities to conduct assessment and research under the pilot scheme. She was eventually appointed to head this initiative. To Dr Hui, what was the most rewarding about assessing the pilot scheme was the smooth implementation attributed to the students, who were taught by her and other research members and are now engaged in key positions at major organisations, including the Hong Kong Young Women’s Christian Association (HKYWCA) and the Salvation Army.

The research focuses on five development areas of young children, including gross motor skills, fine motor skills, cognition, speech and social emotions. The golden period for intervention is between birth and six years of age. “Delayed language development may lead to many inappropriate behaviours among young children, the primary cause of which is the inability to express their needs. As such, helping children with language development can strengthen their social and communication skills, enabling them to manage their own emotions and behaviour,” said Dr Hui as one of the chief principal investigators. In addition to assessing and treating children with special educational needs at participating kindergartens and child care centres, dedicated teams from the HKYWCA and the Salvation Army explained young children’s development and learning needs to teachers and parents. During this process, Dr Hui’s team observed, studied and prepared reports to make suggestions for improvements so that they would become part of the regular services.

According to LEE Man-shan, supervisor of the HKYWCA, nursery schools in the association adopted integrated education in the 1980s. Later they discovered that early intervention would allow more children to receive timely treatment. As a result, the HKYWCA introduced rehabilitation services for young children in 2011, starting in Tin Shui Wai. “From our service in Tin Shui Wai we saw the number of children with special needs rising. Learning disabilities, autism and delayed language development were common issues,” said Lee. Lack of awareness was daunting challenge at times as some parents failed to notice delayed development in their children or attributed delayed development to emotional distress or temper tantrums. Worse still, some parents noticed certain abnormalities but deferred or refused to take action because they refused to accept the reality. A few years ago, it was realised that many children failed to get treatment in their golden periods because of lengthy waiting times caused by a surge in the number of children in need of rehabilitation services. “Research suggests that while genes play a major role, environmental factors deserve focused attention. It is clear that if we fail to provide timely services, it will prove more difficult for these children to fit in mainstream schools and the community,” added Lee. She also highlighted the importance of public education, saying, “the public have certain misconceptions about these children. Generally speaking, wider social acceptance delivers a positive message that parents should feel comfortable to allow their children to be treated and included in the community.” Therefore, the pilot scheme aims to facilitate cooperation among schools, families and the community so that timely rehabilitation services can be provided to children with special needs, which is of paramount importance.

Similarly, Miranda TANG, service supervisor of the Salvation Army Sky Family and Child Development Centre, stressed the critical role of pre-school intervention while acknowledging the benefits of on-site services in the scheme. She said, “Early intervention is what we wanted to do. This scheme allowed us to be at school, to communicate with parents and teachers in person, to understand what school children really needed. Schools are important to families as they provide major environments that children live in. By getting into school, we learned about the daily activities of students and their actual needs, and we were able to conduct a more accurate assessment of greater accuracy and more suitable training. Moreover, as teachers and parents felt helpless from time to time, we could serve as a bridge providing access to professional advice, knowledge and moral support while reducing their burden by guiding them to adjust expectations for their children.” WONG Kai-yan, a clinical psychologist, said, “We paid family visits with social workers, speech therapists and occupational therapists to investigate the conditions and carry out relevant assessments. We guided parents in choosing suitable toys to play with their children, observing reactions and achieving interaction. We hoped to educate parents about the importance of family It was easier for children to learn movements and balance at the initial stage of growth due to the quick progress in the development of gross and fine motor skills, according to Dr Hui. Facilities and teaching materials at Salvation Army. The CityU research and consulting team: (from left) Associate Professor Dr Sam Ye, Associate Professor Dr Anna Hui, Assistant Professor Dr Chen Hui-fang and Associate Professor Dr Elaine Au, from the Department of Social and Behavioural Sciences. participation in the entire rehabilitation process. Home-based training is much more efficient in facilitating recovery than a few hours spent with some therapists on a weekly basis.” Social workers paid regular visits to participating families, and recorded the progress of each child.

Dr Hui found that inadequate space in school was the most difficult part in implementing the scheme. She noted, “Land shortage is one of the most common issues facing Hong Kong. Sometimes we needed a quiet environment for assessment and treatment of children with special educational needs, so some kindergartens had to provide their principal’s room for this purpose due to limited space.” To address this issue, one of the organisations offered to arrange for a mobile training centre near the school, so that parents could take their children onboard for assessment and treatment. However, some of the schools were unable to provide suitable parking, so there were concerns to ensure safety access for students. All of these are restrictions stemming from land shortage. Furthermore, kindergarten teachers were sometimes too busy at work to effectively communicate with the therapists.

Speaking of the five service areas studied, Dr Hui said, “It was easier for students to learn how to jump, run, play with toys and balance the body at the initial stage as we saw noticeable progress in the development of gross and fine motor skills. However, more time was needed at the subsequent stage, which involved cognition, speech and social emotions. Dyslexia at this stage of childhood was categorised into the domain of cognition, meaning that we could only identify but not diagnose it. At Primary One, educational psychologists would first conduct an intelligence (IQ) test for suspected cases. A dyslexia test would follow if a normal IQ score was obtained, and the disability could be diagnosed only when the test identified difficulties in processing texts. There are two parts of human language: comprehension and speech. Those suffering from dyslexia have no problem with speech, so they can give verbal answers without difficulty, but when asked to read and comprehend they show some kind of problem.” With regard to the current situation of primary schools, Dr Hui summarised that students with three main disorders require special education. The disabilities are dyslexia, autism, and attention-deficit/hyperactivity disorder, with dyslexia the most common. Dyslexia treatment delivered by speech therapists and educational psychologists is relatively complex, and the treatment differs between Chinese and English. While students need to be taught to break down Chinese characters, they are trained to listen when it comes to English. A large number of students are waiting to receive services for these three main disorders, and the government is trying to relieve the situation. We will be taking a meaningful step forward, not just for students, parents and schools, but also for the society if relevant services and early intervention are offered at the early childhood stage.

Dr Hui is also concerned about the interface between kindergarten and primary school education for students with special educational needs. She hopes that all case files of kindergarten students can be submitted to the Social Welfare Department (SWD), so that the SWD and the Education Bureau will be able to follow up. In this way, Special Educational Needs Coordinators and teachers can arrange for future services and curriculum adaptation for Primary One students without having to go through any assessment. In addition, she expects her research findings to help train social work and psychology undergraduates to handle cases of such special students.

Dr Hui was grateful for the opportunity to work with many graduates in the pilot scheme. She saw that these CityU graduates, including Lee Man-shan of the HKYWCA, Miranda Tang of the Salvation Army and Wong Kai-Yan, delivered what they have learned to their professions, giving back to the society with expertise and dedication and showing CityU’s motto “Officium et Civitas”.