View source for How to support CWSN

[[Category:TIIE-Toolkit]]

=== '''Who are CWSN?''' ===
According to the Rights of Persons with Disabilities Act, 2016,"Person with disability" means a person with long term physical, mental, intellectual or sensory impairment which, in interaction with barriers, hinders his full and effective participation in society equally with others. A "Person with benchmark disability" means a person with not less than forty percent of a specified disability where specified disability has not been defined in measurable terms and includes a person with disability as certified by the certifying authority. 

In clinical diagnostics and functional development, special needs or additional needs refers to individuals who require assistance for disabilities which may be medical, mental, or psychological. Please refer to this page for more information: [https://en.wikipedia.org/wiki/Special_needs Special needs.]

The types of disabilities have been increased from existing 7, such as Physical Disability, Intellectual Disability, Mental Behaviour (Mental Illness), Disability caused due to Chronic Neurological Conditions and Blood Disorder, Multiple Disabilities to 21 disabilities and the Central Government will have the power to add more types of disabilities.


The Act covers the following 21 specified disabilities:

# Blindness
# Low-vision
# Leprosy Cured persons
# Hearing Impairment (deaf and hard of hearing)
# Locomotor Disability
# Dwarfism
# Intellectual Disability
# Mental Illness
# Autism Spectrum Disorder
# Cerebral Palsy
# Muscular Dystrophy
# Chronic Neurological conditions
# Specific Learning Disabilities
# Multiple Sclerosis
# Speech and Language disability
# Thalassemia
# Hemophilia
# Sickle Cell disease
# Multiple Disabilities including deaf-blindness
# Acid Attack victims
# Parkinson’s diseas 

=== '''Support provided by the Education Department :''' ===
The Education department has made provisions through the DIET at a district level, through the BRC at the block level, through CRC at cluster level and through IERT at school level to provide resource support in terms of trained personnel, educational materials, equipments (aids and appliances) and monitoring of learning outcome of CWSN as is mentioned in state policy. For instance, in Bengaluru South 3 Block, there are 4 Block Inclusive Education Resource Teachers (BIERTs), who serve 145 primary schools and 46 high schools. All four have specialised in learning disabilities, hearing and visual impairments, and mental retardation as a part of their Bachelor of Education studies. 

The government schedules bi-weekly psychotherapy sessions for severely disabled CWSN students (those unable to attend school). For those with Unique disability identification card (UDID) , it also offers MR kits and scholarships. Additionally, some public hospitals, including Victoria, Sanjay Gandhi, NIMHANS, public general hospitals, etc. also diagnose students' difficulties. Doctors are available one or two days a week at the relevant hospital, but one should check the doctors' details and areas of expertise before going to the hospital. 

=== '''Block level resource centre?''' ===
[https://www.schooleducation.kar.nic.in/ssa/pdfdocs/InclusiveEducation.pdf Inclusive Education activities at the block & cluster level depended on the local situations.]

=== '''How to support Intellectual disability and SLD children?''' ===
Some children can be easily identified for special needs based on their medical history. For example, they may have a developmental disorder, visual or hearing disabilities, or other disabilities like intellectual disability etc. For students with less obvious disabilities, such as those with a borderline intellectual disability or specific learning difficulties (dyslexia, dyscalculia, etc.)., before conducting a comprehensive diagnostic evaluation, teachers must determine how well their students are performing academically in relation to their age group. Additionally, screening of the students should be done at the school level using a checklist to identify any students who may have learning difficulties by the concerned teacher or class teacher. If a teacher notices a student having problems, they should inform and take assistance from specially designated department members, such as BIERTs, and with the parents’ help should contact a clinical psychologist at a relevant hospital, such as NIMHANS or Victoria in Bangalore.

==== '''LD Diagnostic process:''' ====
The diagnosis will require a team approach involving a paediatrician and a clinical or rehabilitation

psychologist. This would involve the following steps:

'''1. Assessment by paediatrician:''' The paediatrician will do the initial assessment. This will involve

a detailed neurological examination including vision and hearing assessment. It has to be ensured that

the child has normal visual acuity and hearing before proceeding to the next step. Following that, the paediatrician will conduct a comprehensive clinical evaluation and assessment that includes detailed counselling with parents, teachers, and any other relevant parties. If the child is physically underdeveloped for their age, a physician may also recommend some tests to determine how well the child is growing and developing. 

'''Comprehensive counselling questionnaire for parents:'''

# Chronological list of  issues faced with duration
# Main reasons for consultation
# Family history:
## Genogram/family  tree (Preferably three generations and indicating abortions,  perinatal deaths, twins, affected members, etc.,)
## Family  history of illness (Neurodevelopmental disorders, other handicaps,  epilepsy, psychiatric illness, substance use disorders,  neurological illness, early death, suicidal attempts, completed  suicide)
## Consanguinity  among parents (Father married to sister’s daughter, mother’s  brother’s daughter, father sister’s daughter, etc.,).
## Descriptive  account of parents/significant others/other family members if  relevent including age, education, occupation, and other relevant  details)
## Family  life and relationships(including family setup and environment,  living conditions and current living arrangements, cohesiveness,  parental relationships, emotional atmosphere, parent-child  relationships, relationship with siblings, communication style in  the family, child-rearing practices, daily life pattern, the stress  in the family, including family’s understanding of the illness,  and treatment expectations etc).
# Personal History:

# Pre-natal factors (state of mother during pregnancy, Nutritional deficiencies, teratogen exposure, infections (measles etc), fever, antepartum bleeding, Rh incompatibility, maternal stress, maternal disease(Hypertension, diabetes, pre-eclampsia, toxaemia, hypothyroidism, psychiatric illness, etc), any other)
# Perinatal factors (including neonatal - Premature, post-mature prolonged labour, foetal distress, Assisted labour, abnormal presentation, placenta praevia, induced labour, cord round the neck, caesarian section, any other)
# Child at birth (Birth weight, Cry-normal, delayed/no cry, congenital anomalies(including small head), others like Apneic spells, cyanosis, jaundice, need for resuscitation)
# First four weeks (Respiratory distress, excessive crying, cyanotic attacks, feeding problem, jaundice, high fever, fits, altered sensorium,. Hypoglycaemia, fever, incubator care, any other)
# Developmental history (delay present/absent, current level of development, including mother’s estimation of mental age)
# Developmental milestones(Motor-head control, sits without support, independent walking, runs well. Etc, cognitive-visual tracking, reaches for objects, scribbles,etc, social-smile, recognizes mother, imitates, etc, speech/language-babbling, etc)
# Temperament and personality traits(Give an account based on child’s sociability, emotionality(general mood, affect regulation), attention/concentration, activity level, impulsivity, adaptability, others); also excessive shyness, aggressive tendency etc.)
# Schooling(Age at admission to school, type of school-regular/special, academic performance, participation in extracurricular activities, change of school and reason for changing school, the highest class achieved, difficulties in school including academic difficulties, bullying experiences, and if not attending school, mention duration of absenteeism and child's routine in brief)
# Menstrual and sexual history
# Hobbies, interests, talents, strengths
# Past history (Significant medical/ psychiatric problems prior to the onset of present illness including medication and treatment that the child may have received till date including interventions received and if any improvement was perceived with those interventions)
# History of presenting illness (Describe onset, ppt factors, maintaining factors, stressors, chronological evolution of symptoms, current problems, treatment history till date, negative history, family perception and responses to the problem).

'''Comprehensive counselling questionnaire for teachers:'''
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'''Psychiatrist notes the following things during child examination:''' Comfort level, cooperativeness, rapport, social responsiveness, speech and language skills, alertness, attention and concentration, activity level, mood and affect (subjective and objective), thought processes, perception, general intelligence, etc.

'''2. IQ Assessment: A''' clinical psychologist will perform the IQ assessment using MISIC or WISC-III. If the IQ is determined to be >85, then step 3 will be applied.

'''3. SLD Assessment:''' This would involve the application of specific psychometric tests for diagnosing

SLD and giving it a severity scale.

'''Diagnostic Tool''' - The diagnostic tool to be used for the SLD assessment is National Institute for Mental Health and Neurosciences (NIMHANS) battery for a diagnostic tests for SLD. The same is to be performed by a Rehab/Clinical Psychologist.

The detailed assessment report will be shared with parents and teachers of the respective schools for their individual educational plan and their review. 

=== '''How to get Unique Disability ID Card (UDID) ?''' ===
'''What is UDID :''' Unique ID for Persons with Disabilities.

==== '''Who can apply for UDID?''' ====
According to the Persons with Disabilities Act of 1995, the following types of disabilities are eligible to apply for UDID cards,

# Blindness: “Blindness” refers to a condition where a person suffers from any of the following  conditions namely:-
## Total  absence of sight; or
## Visual  acuity not exceeding 6/60 or 20/200 (Snellen) in the better eye  with correcting lenses; or
## Limitation  of the field of vision subtending an angle of 20 degrees or worse;
# Cerebral Palsy: “Cerebral Palsy” means a group of non-progressive conditions of a person  Characterized by abnormal motor control posture resulting from brain insult or injuries occurring in the pre-natal, peri-natal or infant period of development;
# Low vision: ”Low Vision” means a person with impairment of visual functioning even after treatment of standard refractive correction but who uses or is potentially capable of using vision for the planning or execution of a task with the appropriate assistive device;
# Locomotor Disability: “Locomotor disability” means disability of the bones, joints or muscles leading to substantial restriction of the movement of the limbs or nay form of cerebral palsy;
# Leprosy-cured: “Leprosy-cured person” means a person who has been cured of leprosy but is  suffering from
## Loss  of sensation in hands or feet as well as loss of sensation and  paresis in the eye and eye lid but with no manifest deformity;
## Manifest  deformity and paresis but having sufficient mobility in their hands  and feet to enable them to engage in normal economic activity;
## Extreme  physical deformity as well as advanced age which prevents him from  undertaking a gainful occupation, and the expression ‘Leprosy  Cured” shall be construed accordingly;
# Mental Retardation: “Mental retardation” means a condition of arrested or incomplete development of the mind of a person which is especially characterized by sub-normality of intelligence;
# Mental Illness: “Mental illness” means any mental disorder other than Mental retardation
# Hearing Impairment: “Hearing Impairment” means loss of sixty decibels or more in the better ear in the conversational range of frequencies

==== '''Steps for applying UDID certificate :''' ====

# Complete the testing procedure, as per instructions provided by the Department of Clinical Psychology.
# All persons with disabilities can apply for the  UDID using the given link here, https://www.swavlambancard.gov.in/  PwDs are required to register themselves on the UDID portal. Once registered, after the login is complete, they will be able to apply online for a Disability Certificate. They will also be able to track the status of their application. They can put forward their request for renewal of their Disability Certificate/UDID Card and also request for another card in case of loss of their UDID Card. They can also download and print a copy of their respective Disability Certificate/UDID Card. One of the unique features is be the ability to locate their CMO Office/Medical Authority for assessment of disability, District Welfare Officer to receive assistance and to know about the various schemes for Persons with Disabilities. They will also be able to view the latest news/announcements pertaining to disabilities.   For information on UDID registration, use this link https://www.swavlambancard.gov.in/pwd/application to access the online form that must be filled out. There are four sections in the application form, which are listed below. All sections must be filled out correctly, and the supporting documents must be attached.   '''Four types of details are required:'''
## Personal  Details including Address
## Disability  Details
## Employment  Details
## Identity  Details  '''Document required with the online application:'''
#* Scanned  copy of the recent color photo.
#* Scanned  image of signature (Optional)
#* Scanned  copy of Address Proof (Aadhar/Driving License/State Domicile etc)
#* Scanned  copy of Identity Proof (Aadhar Card/PAN Card/Driving License etc)
#* Scanned  copy of Disability certificate (Only for those Persons with  Disability who have been issued disability certificate is by the  competent Authority).
# Complete UDID registration by filling in all details on the online form. After filling out the form, you will receive an acknowledgement slip for the same. Print out this acknowledgement slip. 
# Submit the acknowledgement slip in the respective department in the visited hospital and collect an IDD disability form(In NIMHANS, go to MS Office in the Ashwini Block (https://goo.gl/maps/pJHF98qTPJvtPyUV7, near NIMHANS Heritage Museum).
# Submit the form to the Department of Clinical Psychology (wherever you have been asked to report). The IDD Disability Form will be filled, signed, and stamped.
# Submit the filled form back to the same department where you get the IDD form. After completing the above process, the UDID registration will be completed. You will receive the UDID card and pension in about 3 months’ time.

=== '''Teaching-learning Strategies and practices?''' ===

# [https://ncert.nic.in/pdf/publication/otherpublications/SpecialNeeds.pdf Including children with special needs_NCERT]
# [https://n20.ncert.org.in/pdf/publication/otherpublications/tiicsnups101.pdf Including children with special needs_NCERT]
# [https://ncert.nic.in/pdf/publication/otherpublications/COVER.pdf Meeting special needs in schools_NCERT]
# [https://ncert.nic.in/pdf/announcement/Inclusion_in_Eduction.pdf Inclusion in education_NCERT]
# [https://ncert.nic.in/degsn/pdf/NonPrint/Index_Inclusiveness.pdf Index of Inclusive education_NCERT]

'''Reference:''' 

# Persons with Disabilities (Divyangjan) in India http://www.nhfdc.nic.in/upload/nhfdc/Persons_Disabilities_31mar21.pdf
# screening Checklist for School Students - NCERT https://www.edudel.nic.in/upload/upload_2021_22/289_300_dt_02052022.pdf