DOCUMENT RESUME

ED 053 499 EC 032 877

TITLE The Provision of Education for Pupils Who AreHomebound or Hospitalized.

INSTITUTION Ontario Dept. of Education, Toronto.PUB DATE 71NOTE 24p.

EDRS PRICEDESCRIPTORS

ABSTRACT

EDRS Price MF-$0.65 HC-$3.29Administration, *Educational Programs, *ExceptionalChild Education, *Homebound, *Hospitalized Children,Physically Handicapped, Special Health Problems,Teacher Role

Suggestions are made for administrators responsiblefor the establishment and supervision of programs and services forchildren who are homebound or hospitalized and for teachers of suchchildren. The section for the administrator considers programobjectives, program merits, responsibilities and supervision, pupileligibility, referrals, termination of home instruction, teacherselection, parent responsibilities, and programs for the emotionallydisturbed, severely retarded, and learning disabled. Recommendationsfor teachers include teacher role, supportive consultants, making acommunity directory, self-help, procedure subsequent to referral,initial home visit and lesson, the hospital setting, teamconferences, time 'for instruction, and record-keeping. Types ofprograms and aids and a glossary are also included. (RJ)

The Proyisionof Education for'Pupils who areHomebound or\Hospitalized

Special Education BranchDepartment of EducationProvince of OntarioToronto, Ontario

U.S. DEPARTMENT OF HEALTH, EDUCATION& WELFARE

OFFICE OF EDUCATIONTHIS DOCUMENT HAS BEEN REPRODUCEDEXACTLY AS RECEIVED FROM THE PERSON ORORGANIZATION ORIGINATING IT. POINTS OFVIEW OR OPINIONS STATED DO NOT N ECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION POSITION OR POLICY.

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The Provisionof Education forPupils who areHomebound orHospitalized

1971

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ContentsEC032877

Preface 4

Part A AdministrationI Objectives of Programs 5

II Home and Hospital Instruction Programs Advantages and Disadvantages 5III Responsibilities of a Senior Official 6IV Supervision 6V Eligibility of Pupils 7

VI Referrals 7VII Termination of Home Instruction 8

\., VIII The Selection of Teachers 8IX The Responsibilities of Parents 9X Programs for Pupils Who Are Emotionally Disturbed or Mentally ill 9

XI Programs for Pupils Who Are Severely Mentally Handicapped 10XII Programs for Pupils with Learning Disabilities 12

Part B The TeacherXIII Teaching in Home and Hospital Programs 13XIV Do's For Teachers 14XV Supportive Consultants and Allied Personnel 14XVI Build-it-yourself Directory of Community Agencies 15

XVII Self-help for Teachers 16XVIII Teacher's Procedure Subsequent to Receipt of a Referral 16

XIX The Initial Home Visit 16XX The Initial Lesson 17XXI The Hospital Setting 17

XXII Participation in Team Conferences 17XXIII Time for Instruction 18XXIV Teacher's Records 18

Part C ProgrammingXXV Types of Programs 19

A. Short Term 19B. Long Term 20C. For Pupils with a Terminal Illness 21

XXVI Instructional Aids 22XXVII The Pupil 23

Appendix Glossary 24

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Preface

The material within this publication offerssuggestions for (i) administrators respon-sible for the establishment and supervisionof programs and services for children andyouth who are homebound or hospitalized,and (ii) teachers of such children and youth.It attempts to present a few guidelines andto indicate current trends. Extensive detailsmay be found in reference books andresource materials pertaining to the subject.

Principles upon which suggestions arebased include the following points:

It is the right of every child to have access toa learning program that will lead him todevelop mentally to his optimum capacity.It is the responsibility of the educationalauthority to provide facilities, resources, andpersonnel to enable him to reach this goal.No child is expendable.

In any program the welfare of eachindividual child must be paramount.

All children with disabilities should be per-mitted to enter regular school programs ona part-time or full-time basis when theirdevelopment so warrants.

If we are truly to help the child who is dif-ferent, we must be preoccupied not with hishandicaps or his weaknesses, but with hispotential and his strengths. He must beaccommodated by programs, services, andcurriculum that will enable him to matureand to learn as much as his capabilities

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permit in an atmosphere of self-respectand dignity.

Education is for leisure time, for a moremature culture, and for a greater sense ofpersonal responsibility. It should encouragediscussion, inquiry, and experimentation.It should enhance the dignity of theindividual.

An educational program for children andyouth who are hospitalized or homeboundis intended to be a means of inclusion in,rather than exclusion from, the total rangeof programs and services provided byeducation.

Education has therapeutic values.

Part AAdministration

Objectives of Programs

The primary objective is to provide educa-tional programs of the same quality andhaving the same goals as the regular schoolprograms from which, by reason of theirdisabilities, the children and youth areexcluded. Thus an important function of theprograms is to ensure continuous instruc-tion while pupils are homebound or hos-pitalized and so prevent educationalretardation due to absence. At the sametime, teachers should aim to transfer pupilsto special or regular classrooms, either ona part-time or full-time basis, as soon asthey are able to attend such classes.

Enrolment in the special programs shouldbe considered only after all possibilities fora modified program within a school havebeen exhausted.

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Horne and Hospital InstructionPrograms

AdvantagesIndividualized instruction is an importantadvantage of these programs for it, in turn,provides several advantages. These includeopportunities to remedy learning gaps,stimulate intellectual curiosity, foster multi-faceted personal development, and encour-age progress at the individual child's ownpace. The circumstances under whichinstruction is given allow the teacher tomake a frank assessment of the child's levelof functioning and create a favourableenvironment for acceptance both byparents and pupil of this assessment andthe immediate and long-range goalsdetermined by it.

DisadvantagesThe c:mwristances and setting in whichinstruction is conducted may lead someteachers and children to regard it as a merebaby-sitting activity. Access to the teacherfor only limited time periods may presentfurther difficulties.

The disabled child's isolation is a seriousdisadvantage if extended for months oryears. The lack of stimulation from peers,limited contact with the community, limitedsocial and group experiences all may createa situation similar to that of the culturallydisadvantaged.

To an over-protective, over-anxious, pos-sessive parent a home instruction programmay seem desirable, but the child mayexperience detrimental effects on his self-respect and life values.

From a practical standpoint, the task oftransporting bulky instructional aids mayconstitute a serious disadvantage for theteacher.

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Responsibilities of a senior official

The first task of a senior official responsiblefor Special Education is to outline an overalland long-range plan for the education andthe social and vocational adjustment ofchildren and youth who are homebound orhospitalized. In formulating this plan heshould check the requirements stated in theProvincial Regulations.

He should establish written policies toensure that efficient procedures arefollowed concerning:a) the placement of pupils, wIlether they bereferrals for enrolment in a program ofspecial education or for transfer to a regularclassroom;b) the movement of records medical,educational, psychological needed forplanning educational programs in keepingwith the child's needs and physical limita-tions and with medical recommendations;c) child accounting;d) supervision and support for teachers;e) the acquisition and transportation ofsupplies and equipment for instructionalpurposes;f) the reimbursement of teachers' travellingexpenses;g) the co-ordination of the efforts of thelocal school and of the teacher of the home-bound or the hospitalized in order to effectthe child's placement in a school settingwith the least readjustment difficulty;

h) services to non -rear 3nt pupils (inhospital, etc.);i) children and youti- ironed in detentionhomes, residences pregnant girls,convalescent homes, or similar institutionswithin the community;j) the reporting of educational progress toparents;k) regular periodic evaluation of studentneeds and programming; andI) the selection and scheduling of teachers.

For teachers of pupils who are homeboundor hospitalized, a senior official responsiblefor Special Education should provide:a) a home-base for maximum program

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co-ordination and staff morale, in which tomaintain essential records and reports, toplan and prepare instructional materials,and to store instructional material andequipment;b) a wide range of materials and equipment;c) opportunities to participate in in-serviceprograms related to their own activities, allfacets of special education, and trends ineducation in general, in order to minimizefeelings of isolation and stagnation;d) supportive assistance from specialistsconsultants, supervisors, master teachers

in the various subject areas (e.g. music,art, physical and health education, speechcorrection, science) as well as the fullresources of ancillary special educationand student services personnel;e) adequate time for preparation andplanning, and for conferences with parentsor others involved with a child;f) clearly defined procedures concerningthe enrolment and the transfer of pupils, theacquisition of supplies, travc,wig expenses,and lines of responsibility a ,uthority;g) parking arrangements with '..;e properauthority when a teacher is giving instructionin a hospital, a residence for pregnant girls,a detention home, a convalescent home,or a private home in a restricted parkingzone;h) easy accessibility to pertinent recordsconcerning pupils; andi) adequate health protection from contactwith communicable diseases, fatigue, andundue frOstration.

Further, it is the responsibility of the SpecialEducation Senior Official to guard againstthe misuse of home instruction programs todisguise the need for additional educationalprograms and services. In devising his pro-grams he should allow for the partial par-ticipation of many homebound children inmodified programs within a school setting.Lastly, with the assistance of teachers ofhomebound pupils, he should be on hisguard against needlessly confining to homeinstruction the child of an over-protective,over-anxious, possessive parent.

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Supervision

Often the immediate supervision of a homeor hospital program is the responsibility ofthe principal of the school that the child oryouth would ordinarily attend. An exceptionto this pattern might be programs forindividuals who are chronically or terminallyill, for which the Special Education SeniorOfficial may assume responsibility. In eithercase, supervision by a knowledgeableleader is required.

In addition to the task of supervising theinstructional program, the duties of thesupervisor will centre on assisting theteacher of the homebound or hospitalized.This will include securing the co-operationof parents and ensuring that they under-stand their responsibilities; helping teachersto select and procure appropriate educa-tional materials and equipment for individualchildren; arranging conferences betweenregular teachers and the teacher of thehomebound or hospitalized; and easing thelatter's sense of isolation by arrangingin-service programs and encouraging activeparticipation in other professional meetingsand activities.

The supervisor will also assist with thescheduling of teachers, taking into accountthe following factors:a) travelling time (distance, traffic, and roadconditions);b) number of pupils enrolled;

c) grade and achievement of each pupil;d) medical recommendations concerningpermissible activities;e) treatment routines and family routines;f) time for preparation of materials, reports,and records;g) interviewing and planning for and with anew pupil;h) conferences with parents and with otherprofessionals;i) appropriate instructional program;j) direct and frequent communication withlocal school faculties; andk) pick-up and delivery of heavy orawkward instructional materials.

The supervisor may also assist in theco-ordination of medical, psychiatric, andsocial work recommendations with aneducation& plan, and assume responsibilityfor interpreting home and hospital programsto other school administrators and to privatephysicians.

A sincere interest on the part of the principalin the progress and welfare of children oryouths who are homebound or hospitalizedcontributes a great de& toward good com-munity relations, His sympathetic concernwill likely be reflected in co-operativeattitudes among the regular classroomteachers on his staff.

VEligibility of pupils

No child or youth should be enrolled forhome or hospital instruction without thewritten recommendation of a physician. Thepresence of one of the following conditionsis assumed, and the illness referred to maybe physical or emotional: (1) a chronic,long-term illness; (2) a convalescent phaseof an acute illness; (3) a period of confine-ment to home or hospital following atraumatic episode or a surgical procedurethat will require at least four weeks ofrestricted activity; or (4) a physical handicapthat prevents regular school attendance.

It should be stressed that children or youthssuffering from an infectious disease are noteligible during the contagious stages.

Page 9 of this guideline should be con-sulted for comments concerning homeinstruction for children who are emotionallydisturbed or mentally handicapped.

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VIReferrals

It is important to establish clearly to whomreferrals are to be made. Referrals areusually made through the principal byparents, public health nurses, or socialworkers.

One specific supervisor should be assignedthe responsibility of allocating each pupil toa teacher of the homebound or hospitalized.

A principal or parent may place a referralby telephone. The following information maybe recorded immediately: name, address,and telephone number of child; name ofschool and grade attended; illness andanticipated length of absence; date ofreferral.

When placement has been confirmed, aduplicate copy of this information shouldbe given to the teacher who is assigned tothe pupil.

A letter must be obtained from the physicianor psychiatrist stating the nature andexpected duration of the illness. He maypresent, as well, recommendations concern-ing restricted activities, and so forth. Theschool nurse may visit the home in order toobtain permission to contact the physicianand to pave the way for the family'sco-operation with the teacher and herschedule.

A letter of consent should be obtained fromthe parents. The physician may requestauthorization from the parent as well.

These procedures should be well co-ordinated in order to avoid more than afew days' lapse between the referral andthe initiation of instruction.

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VIITermination of home orhospital instruction

A child or youth may be removed fromhome/hospital instruction for one of threereasons:

1 The reason for placement on home/hospital instruction no longer exists. Theillness or handicapping condition has beencorrected or improved, and the doctor hasgiven permission for the pupil to attendschool.

2 The pupil no longer benefits from instruc-tion, due to a deterioration of his condition.A statement from the physician shouldconfirm the assessment.

3 A temporary suspension may be neces-sary when parents refuse to co-operate. Assoon as minimum standards are met, homeinstruction should be resumed.

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VIIIThe selection of teachers

The uniqueness of a child or youth with ahandicap or illness that confines him tohome or hospital places him within theresponsibility of special education.Optimum qualifications of visiting oritinerant teachers who participate in homeand hospital programs therefore include,in addition to a basic teaching certificateand varied classroom teaching experience,(1) a rich general arts education to meetthe demand for instruction at many levels inmany areas; (2) specific education in facetsof special education, including child growthand development, child-family relation-ships, the psychology of exceptionality,recognition of individual differences andneeds, knowledge of severe emotionalproblems, experience with methods andmaterials for teaching multiple disabilities;and (3) knowledge and skill in the tech-niques of counselling and interviewing.

In order to make the best use of theirparticular skills and training, teachers aregenerally assigned to either elementary orsecondary school pupils. At the secondaryschool level, teachers may be assignedto one or more of the following areas:mathematics and science; English and thesocial sciences; foreign languages; voca-tional subjects; and occupational pupils,

Desirable characteristics of the idealteacher for homebound and hospitalizedprograms include:

1 the ability to adapt to unusual teachingsituations and varied home conditions;

2 good physical and mental health, includ-ing such aspects of maturity as self-understanding, an awareness and apprecia-tion of personal pressures, biases andprejudices that may affect situations;

3 sensitivity to and empathy for the currentneeds of others;

4 flexibility the ability to shift plans,schedules, or approach, quickly andcomfortably;

5 skill in public relations and the ability toget along well with others;

6 a warm, friendly personality and anappreciation of the viewpoint of others;

7 willing and optimistic acceptance of thechallenge of aiding incapacitated individ-uals by means of educational enrichment,remediation, and adjustment, and the abilityto feel at ease with severe, disfiguringphysical handicaps;

8 the ability to work and to plan independ-ently while keeping the teaching role inperspective as one part of a continuousprogram for the well-being of each child;

9 skill in educational diagnosis and insynthesizing the varied knowledge andconcepts of many fields;

10 the ability to provide a constructive,mentally wholesome environment in spite ofprogressive disabilities, varying standardsof order and cleanliness, and of conflictingvalues;

11 a keen sense of humour, cheerfulness,tact;

12 a creative imagination, an inquiringattitude, versatility.

Although teachers may be employed forhome and hospital programs on either afull- or part-time basis, instructionshould be provided within regular schoolhours. As a part of the total range of pro-grams and services, home and hospitalinstruction should not be viewed as an after-hours salary supplement, or as a wearisomeduty at the end of a busy daily schedule.

IXThe responsibilities ofparents

Theoretically, one hour of individual instruc-tion is equivalent to one day of regularclassroom instruction. Obiiously it is im-practical to devote long periods to study orpreparation while the instructor is present.Each visit should be spent in the presenta-tion of new material, the explanati,'), ofnew processes, and discussion of newassignments. It then becomes the student'sresponsibility, under the supervision ofthe parents or guardians, to prepare workwhich has been assigned. Instruction timeonce lost is difficult to regain, for time isat a premium in this program.

During the initial visit, the teacher usuallyexplains the program and the schedule.Many find it helpful to prepare a form letterfor parents which outlines their responsi-bilities. Items to be included in such a letterinclude the following suggestions:

Have your child ready for instruction whenthe teacher arrives. Keep the child's equip-ment (crayons, scissors, pencils, papers)together so that they are readily availablefor use when the teacher begins instruction.

The room in which instruction is to be givenshould be quiet and should have sufficientlight, properly placed. All members of thefamily should stay out of the classroom

during the instruction period, and careshouldbe taken to avoid interruption anddisturbance (loud radio or televisionprograms, etc.).

Try to provide a comfortable working areafor the child a solid writing surface suchas a card table, bedside table, or desk, anda comfortable chair. A suitable chair shouldbe provided for the teacher.

Set aside a certain time each day in whichthe child is to do the work assigned. Checkto see that he has completed the assign-ment and show an interest in his work, butrefrain from helping him too much.

School books and other materials left forthe child's use should be returned in goodcondition to the special teacher when thechild returns to school. (This is an expensiveprogram. The child should attend a schoolas soon as the doctor will give permission.)

If for any reason the child cannot take hisinstruction period on a particular day, kindlycontact the teacher or supervisor by tele-phone before 8:00 a.m. or 1:00 p.m., so thatthe teacher may use the time to assistanother child.

Please adhere to the schedule forinstruction as closely as possible.

XPrograms for pupils who areemotionally disturbed ormentally ill

Pupils whose behaviour is so peculiar asto interfere significantly with the progress ofothers, those who make disturbing assaultson their classmates, or those who areabnormally afraid to leave home may beregarded as candidates for home instruc-tion. It is more than likely that some of thesechildren are seriously ill and in need ofpsychiatric treatment. Ideally, home instruc-tion in such cases should be only atemporary expedient, to be resorted to untilthe children are transferred to - residentialtreatment centre.

Some children whose behaviour is such thattheir education cannot be conducted inthe company of others may receive individ-ual instruction in a place other than theirhomes. If these pupils are required to dress,walk from their homes to an office in aschool or administration building at a fixedtime, and work there individually with ateacher, the challenge presented is muchgreater than if the teacher were to visitthe several homes.

When a child is unusually and persistentlyreluctant to leave his home, as may occurwhen a diagnosis of school phobia is pre-sented, some of the following progressivesteps by the home instruction teacher mayprove helpful:

1 Offer instruction in the home withoutreference to the school building or the classactivities.

2 Make casual references to the school andto the program pursued by the others ofthe same age group.

3 Visit the school with the pupil to borrow abook from the library or on some otherpretext.

4 Take the pupil to the school to do aspecial test in an office apart from otherchildren.

5 Teach the pupil in a room in the school.

6 Encourage and assist the pupil in hisefforts to overcome his reluctance to attend

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one or more classes with other pupils.From time to time, remind him that he will beasked to participate in discussions onlywhen he raises his hand and that he haspermission to leave the room if he is unableto withstand the strain.

7 Offer the pupil encouragement to attendmore classes and to gradually participateon an equal basis with other pupils.

8 Discontinue regular visits but buttress thepupil's morale with regular telephone calls.

9 Discharge the pupil from home instructionand transfer him to the jurisdiction of hisown school.

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XIPrograms for pupils who areseverely mentally handicapped

The home instruction program for thetrainable retarded child should bepractical. Materials and instruction shouldbe restricted to those areas that have provenof value with such children, namely, orallanguage development, sensory motor ac-tivities, visual and tactual training activities,basic number concepts, fine motor skills,arts and crafts, and self-help skills.Materials selected or prepared by the homeinstruction teacher may help parents in thefollow-up program.

During the home instruction teacher's visits,activities and materials should be discussedwith the parents. Daily work and playperiods, some of which may involve theparticipation of the parents, should beplanned so as not to disturb householdroutines or tire the child.

A daily schedule of routine activities formsthe base of the program. Routine activitiesplay a very important part in the trainableretarded child's life, his regular performance

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of self-help activities at home will helpmaintain skills acquired at school.

Outlines of carefully planned procedureswill assist parents in establishing dailyroutines in self-help skills, sensory motordevelopment, oral language and numbergames, and craft activities. The proceduresfor working periods should be plannedin a step-by-step progression and thelearning materials organized in such a waythat the child may work on his own or withminimal assistance from hIs parents.

In order to balance the daily activitiesbetween active and passive learning, playtime should be unorganized time when thechild is free to play.

The main purpose of the home instructionprogram for the trainable retarded shouldbe to serve as a continuation of the schoolprogram during absence from school andas preparation for the adjustments the childwill have to face on his return to school.

A Sample Daily Program

8:00 a.m.8:30 9:00 a.m.9:10 9:30 a.m.9:30-10:00 a.m.

10:00-11:00 a.m.

11:00-11:30 a.m.

11:30-12:00 p.m.

12:00-12:30 p.m.12:30 1:00 p.m.1:00 1:30 p.m.

Get up, wash, clean teeth, dress.Help to get the breakfast ready. Breakfast.

Wash up and put away dishes.Make bed and tidy own room.Help mother with housework.

Work period (assignment planned for theday by the visiting teacher in speech andlanguage development, number activities,or sensory-motor training).

Free play period toys and games suitablyarranged for the child to play on his own.

Washroom (wash hands).Help to get lunch ready, set the table.Lunch.Wash up and put away dishes for mother.Rest (for mother and child).

1:30 2:00 p.m. Work period (planned by the visitingteacher).

2:00 4:00 p.m. Different activities each day e.g.,shopping; walk with mother; playing orworking in the garden (weeding, sweep thepaths, etc.); craft activities (paint, sew,draw, colour by number, etc.), picture books.

Tea time.Watching television with brothers andsisters.Help to get the supper ready.Supper.Washing up.

Listening to records (songs, stories, etc.);puzzles; games; cards.

Get ready for bed (bath).Look at a book in bed.Lights out.

4:00 4:30 p.m.4:30 5:30 p.m.

5:30 6:00 p.m.6:00 6:30 p.m.6:30 7:00 p.m.7:00 8:00 p.m.

8:00 8:30 p.m.8:30 9:00 p.m.

9:00 p.m.

Family activities

Training period in self-help skills.(follow procedures on charts)

Training period in self-help skills.(follow procedures on charts)

Family activities

Recreational and training activities

Family activities

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XIIPrograms for pupils with learningdisabilities

Children who have specific learning dis-abilities may require home instruction dueto (a) extreme distractibility and hyper-activity in a group situation, or (b) immaturityof a degree that precludes school entranceat the normal age.

If at all possible, extremely distractible orhyperactive pupils should attend school fora period of time so that they may gainthe confidence they will need to eventuallyadjust to and feel comfortable in a class-room situation.

The home instruction program should con-centrate on academic proficiency, espe-cially in reading and arithmetic. Ideas suchas those presented in The Slow Learnerby N.C. Kephart will be more effective thana duplication of the approach taken atschool. Children with learning disabilitiesusually have an intense desire to succeed,and the whole purpose of the home instruc-tion program should be to prepare themto return with proficiency to the classroomsituation.

School age children who are too immatureto benefit from kindergarten instruction maybe taught on a home instruction program.The program involves assisting the parentrather than directly teaching the child.

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ideas such as those presented in A Parents'Guide to Learning Problems by M. Golickwill be useful in helping the parentsunderstand their child.

The program conducted by the homeinstruction teacher should concentrate oncommunication skills in both auditory andvisual perception areas.

The program to be given by the parentsshould involve gross and fine motor devel-opment techniques. A useful outline tofollow is given in Success Through Play byD. H. Radler and N.C. Kephart. Care shouldbe taken to establish a definite, limitedprogram for the parents to follow, so thatthe child does not become overburdenedto the exclusion of normal play. In so doing,the teacher will probably become involvedwith discussions of household routines,such as schedules of meals and bedtimes,which will provide the child stability in hisenvironment.

Regular visits could be made to the schoolthat the child will be attending, and when-ever the child seems settled enough he mayparticipate in some of the programs. Theessential goal is to prepare the child forfull-time school attendance.

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Basically the role of a teacher in a home orhospital is the same as that of classroomteachers. There are a few notabledifferences.

Part 13 The Teacher

XIIITeaching in home and hospitalprograms

Classroom teacher

1 School setting.

Home visiting teacher

1 Wide variety of settings.

2 Selects, constructs, organizes, and adapts appropriate educational methods andmaterials in order to provide skills, attitudes, appreciation, and opportunities fordevelopment.

3 Group and individual instruction. 3 Tutorial instruction.

4 Daily association with fellow educators.

5 Participates in professional groupactivities and in-service education.

6 Plans and prepares daily programs so

7 Infrequent direct contact with homesof pupils.

8 Calls upon specialists (master teachers,principals, supervisors, consultants,counsellors, psychologists) for supportiveassistance.

4 Infrequent association with fellow edu-cators; hence a sense of isolation at times.

5 Participates in the usual professionalactivities, plus special education activitiesand in-service education.

as to use time meaningfully and purposefully.

7 Regular confidential contact with home ofeach pupil.

8 Calls upon medical as well as educationalpersonnel for supportive assistance.

9 Works in a stimulating, competitiveteaching situation in which it is necessaryto be attuned to new ideas and alert topossibilities for professional growth.

10 Experiences periods of frustration inconnection with working conditions, slowprogress of some pupils, etc.

11 Requires skill in working co-operativelywith school personnel at various levels andin different capacities.

9 Works in a non-competitive teachingsituation where professional stimulation iseasily avoided, giving rise to the dangerof self-created stagnation.

10 Occasional sense of futility due to brevityof instructional periods, death of promisingpupil, or transfer of promising pupil toan essentially custodial setting.

11 Requires skills in working effectivelywith all types of parents in all kinds ofsettings, and with allied professionals, aswell as with school personnel.

12 Communicates ways of acquiring knowledge, of applying it of testing it, and ofenjoying it.

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The duty of the home and hospital teacheris to teach, not to advise or to prescribein matters beyond the educational field.She will need to acquire, however, theability to interpret multi-disciplinary reports

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and to understand the medical terms in-volved. She may also be faced with house-hold or hospital routines that requirechanges or modification in the educationalschedules, and co-operation.

The ability to empathize but not oversympa-thize is an important asset that will have tobe developed early in the home teacher'scareer. Contacts with weary, anxiousmothers in need of reassurance, advice,and support will have to be handled withcontrolled sympathy. A little time may be setaside for counselling sessions, but.thismust not become a major portion of thetime assigned to instruction.

Contact with disease, death, suffering anddisappointment will show up the need fora philosophy of life that provides a con-structive framework for such phenomena.The teacher will need support to enable herto accept each child's projected adult lifeor terminal disease.

From a practical standpoint, a knowledgeof streets and of safe driving in all kindsof weather is essential.

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XIVDo's for teachers

Apply your knowledge of child growth anddevelopment in evaluating a child's assetsand areas of weakness and in planninga program that is to his age level. Apply allyour diagnostic, prescriptive, and prog-nostic skills to determine appropriatecurriculum, techniques, and equipment forthe individual child, and to recommend anew placement when he is ready.

Use appropriate audio-visuals and teach-ing-learning aids. Familiarize yourself with,and have a working knowledge of, resourcesavailable in your community. Return bor-rowed books, supplies, and equipmentpromptly when a program is terminated.Recognize your own limitations and seekconsultative assistance. Participate ineducational meetings, conference, andworkshops to gather new ideas for programplanning, to gain moral support, to receiveprofessional stimulation, and to maintainyour perspective of education in general.

Keep an accurate record of the time spentin teaching each child and of his rate ofprogress. Note recommendations forfuture consideration in the educationalprogress of the child. Submit monthly andannual reports and reports at the termina-tion of instruction concerning attendanceand achievement.

Be a friend in each home, but a teacher toeach pupil.

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XVSupportive consultants

Subject area specialists. These includeconsultants in physical and health educa-tion, arts and crafts, music, language,science, speech correction, mathematics,social sciences, primary methods, languagearts, audio-visual techniques, and specialeducation.

Guidance or Student Services personnelPsychologist Services personnelSchool principals and supervisorsAllied professionalsCommunity agenciesRegional Program Consultants and the

Special Education Branch of the OntarioDepartment of Education.

Allied personnelPhysiciansSpecialists (cardiologist, internist,

urologist, neurologist, dermatologist,psychiatrist, etc.)

Nurses (public health, school, hospital,Ontario Society for Crippled Children,C.N.I.B.)

Social workersOccupational therapist, from whom the

teacher may borrow or learn about appli-ances to assist pupils; prevocational testingand evaluation; and activities to increasethe self-help skills needed for daily living.

Physical therapist, from whom the teachermay learn about correct positioning forinstruction, study, etc.; correct lifting pro-cedures to prevent injury to teacher andparent (if such lifting should be necessary);prognosis for functional ambulation,improvement of walking posture, etc.; exer-cises and stimulating physical activity thata child may safely perform for relief duringacademic instruction periods.

Recreational therapist, from who ateacher may learn about or borrow materialsrelated to, activities (games, art, music,crafts) that a child can perform to fill in thelong hours and to contribute to academicprogress.

Speech therapist, from whom a teachermay learn about procedures for theimprovement of verbal communication;procedures for establishing communicationin the absence of speech; and proceduresfor determining the level of speech orcommunication that may be expected.

Rehabilitation and vocational counsellor,from whom a teacher may learn aboutestablishing realistic vocational goals;experiences that provide the skills neededlater in vocational education or rehabili-tation services; and various kinds ofhomebound occupations available to thechronically ill.

Psychologist, from whom a teacher maylearn about the relationship of a disability toself-concept; assessed potential andstrengths; learning problems andweaknesses; and the effects of a specifictraumatic experience or performance.

XVIBuild-it-yourself directory ofcommunity agencies

Accumulate a file of regional agencies andassociations from whom the families ofpupils who are homebound may seek guid-ance or assistance. If the local telephonedirectory does not list the nearest branch,seek information from the Ontario offices inToronto, as listed below.

Allergy Information Organization,5 Moford Crescent.Big Sister Counselling Service,34 Huntley Avenue.Boy Scouts of Canada, 9 Jackes Avenue.Canadian Arthritis and Rheumatism Society,60 Overlea Blvd., Don Mills, Ontario.Canadian Association for Children withLearning Disabilities,88 Eglinton Avenue East, Suite 322.Canadian Cystic Fibrosis Foundation,51 Eglinton Avenue East.Canadian Diabetic Association1491 Yonge Street.Canadian Girl Guides Council,50 Merton Street.Canadian Hearing Society,60 Bedford Road.Canadian Heart Foundation,1130 Bay Street.Canadian Hemophilia Society,165 Bloor Street East.Canadian Mental Health Association,52 St. Clair Avenue East.Canadian National Institute for the Blind,1929 Bayview Avenue.Canadian Paraplegic Association,153 Lyndhurst Avenue.Multiple Sclerosis Society of Canada,76 Avenue Road.Muscular Dystrophy Association of Canada,160 Bay Street.Ontario Association of Children's AidSocieties, 32 Isabella.Ontario Epilepsy Association,835 Queen Street East.Ontario Federation for the Cerebral Palsied,350 Rumsey Road.Ontario Association for the MentallyRetarded, 77 York Street.Ontario Society for Crippled Children,350 Rumsey Road.Rehabilitation Foundation for the Disabled,12 Overlea Blvd.

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Information and/or counselling servicesmay also be available from the followingorganizations:Canada Manpower CentresCanadian Red CrossOntario Department of Education,Special Education Branch, Toronto.Ontario Department of Health,Hepburn Block, Queen's Park.(a) Medical Rehabilitation Branch(b) Mental Health BranchOntario Department of Social and FamilyServices Rehabilitation Services,204 Richmond Street, Toronto.Regional ClinicsY.M.C.A. and Y.W.C.A.

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XVIISelf-help for teachers

Membership in the Division of Educators ofHomebound, Hospitalized and Classes forthe Physically Handicapped within yournearest chapter of the Council for Excep-tional Children brings you the followingpublications: the Newsletter of D.E.H.H.P.H.;Exceptional Children; and SpecialEducation in Canada.

In addition to keeping you up to date onthe literature concerning the instruction ofexceptional children, membership in theC.E.C. and in the Special Education Sectionof the Ontario Education Association(O.E.A.) enables you to enjoy contacts withfellow special education enthusiasts andparticipate in annual conferences and groupaction on behalf of exceptional children.

Programming questions may also bediscussed with your Program Consultant,Special Education, in your regional office ofthe Ontario Department of Education.

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XVIIITeacher's proceduresubsequent to receipt of areferral

When a referral is received, immediatelycontact the principal of the school where thechild is registered or the person in chargeof the placement of the child to acknowl-edge the referral and arrange a meeting forthe purpose of obtaining (a) the necessaryacademic information, (b) any relevantdetails that may assist you, and (c) thetextbooks you will require.

As soon as the referral has been confirmed,telephone the parents or guardians toassure them that a program will beginshortly. If possible, discuss the timesavailable for instruction and make anappointment for the initial visit.

Attend the prearranged meeting at theschool and obtain from the classroomteacher and the principal information con-cerning recent units of work in which thepupil has participated, books being used,achievement levels, academic strengthsand weaknesses, date of last attendance,and any helpful retails (talents, interests,etc.) available.

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XIXThe initial home visit

Attempt to understand the parents' prob-lems and the nature of the child's disability.Be a good listener. Appraise the parents'attitude toward the child's condition and itsconsequences.

Explain the responsibility of the parent in thehome instruction program. Acquaint theparents with your schedule and establishthe time for the first lesson.

Make no promises concerning the child'spromotion, academic subjects, and so forth,until you have had the opportunity toassess his capabilities and feasibility ofarrangements.

Discuss the possibility of delays due tocongested traffic, inclement weather, and soon. Discuss also the possible interferenceof unforeseeable family crises.

XXThe initial lesson

Game-type and get-acquainted techniquesprovide a means of observing perceptual,motor, sensory, learning, and conceptualskills without resort to school-associatedtasks which may represent past failures.

Use a workbook specifically for recordingassignments and rate of progress. Try togauge the amount that may reasonably beaccomplished without overtaxing the pupil'sstrength. State each assignment clearly.

It is generally unwise to work in the note-books that were previously used in school.Issue new workbooks for the home/hospitalprogram.

XXIThe hospital setting

Every effort should be made to arrangeadjustments without friction in order to avoidweakening the child's sense of security andconfidence. Mutual respect among educa-tional and hospital personnel for eachother's points of view and varying objec-tives will result in a spirit of co-operation.

The time factor is somewhat more compli-cated as a result of the involvement of otherprofessional workers, established hospitalroutines, therapy schedules, and so forth.An inflexible, aggressive teacher will likelybe considered a hostile hindrance. Closecommunication between the educationalsupervisor and hospital department headscan facilitate the smooth operation of pro-cedures and avoid resentment concerningthe teacher's role.

Beds are generally movable. A cart may bemade available for transporting educationalequipment and materials. The teacher canadjust her schedule to co-operate withhospital procedures.

The teacher may share some areas ofinstruction with hospital professionals. Forexample, the occupational therapist maygive instruction in art, crafts or typing.

Multidisciplinary conferences should bearranged if there are contradictory points ofview concerning the educational program.

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XXIIParticipation in teamconferences

Prepare written reports concerning the childin his educational setting. You should beprepared to document your statements andto answer questions concerning the child'seducation, his behaviour, and his relation-ships, within the limits of an educationalresponsibility.

Ask questions concerning the child'sobserved behaviour and the implications ofeducational plans. Be prepared to presenteducational alternatives.

Make sure that the opinions you express arebased on educational evidence, and assistin establishing channels for action. Considerthe varying viewpoints and routines involved.

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XXIIITime for instruction

Instructional periods for each child will varyin accordance with: (a) school financialresources; (b) enrolment; (c) the physical,intellectual, and emotional status of thechild; (d) staff available; (e) travelling timeinvolved; and (f) provincial regulations.

A full-time teacher in the home and hospitalprogram may be willing occasionally toteach in the evening or on Saturday insteadof a regular school morning in order to co-operate with a hospital routine or to meetwith a parent, if such arrangements do notinterfere with the pupil's progress and bestinterests and if the teacher is granted com-parable free time. Once a schedule hasbeen agreed upon, however, it should bevirtually immutable.

Instruction should rarely be given by aregularly employed classroom teacher asan after-school assignment. Aside fromother serious disadvantages discussed else-where in this guideline, such an arrange-ment would be subjected to interruption byunanticipated staff meetings and pressingfamily responsibilities.

The home-visiting teacher must be preparedfor irregular lunch hours.

Depending on the distances to be travelled,the ages and disabilities of the pupilstaught, a full case load for a home andhospital visiting teacher may be six to tenpupils at any one time.

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XXIVTeacher's records

1 Regular reports required byadministration.

2 Records of (a) routines followed in eachhome or hospital setting, (b) schedules, and(c) general for use in case of teacher'sillness or absence due to emergency.

3 Anecdotal records of the program foreach child, his progress, and currentrecommendations.

4 Detailed summaries of case history dataand recommendations from allied profes-sionals or others involved with the child.

5 Educational assessments.

6 Regular reports to parents concerningeducational progress.

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The itinerant home and hospital programsare planned individually to meet the imme-diate and long-term needs of each pupil.Nevertheless, they may be divided intothree general categories: short-term pro-grams; long-term programs; and programsfor pupils with a terminal illness.

Part C Programming

xxvTypes of programs

Short-term programs

PupilsThese programs are designed for childrenand youths who will need the service for avery short time. Examples include childrenwith relatively uncomplicated fractures, atemporary illness, burns or nephritis, andpupils convalescing from minor surgery orin the last few months of a pregnancy.

Objectives1 to maintain the pupil as nearly as possibleon a level with his regular class so that onhis return he will have few readjustmentproblems;

2 to take advantage of the opportunitiesoffered by individual instruction to achievesome remediation of basic skills and workhabits, to initiate new patterns of study, orto arouse and satisfy intellectual curiosity.

Procedures1 No special teaching procedures or devicesare needed for most short-term pupils.

2 The home or hospital teacher shouldarrange a weekly conference with theregular classroom teacher to maintaincontact between the child and his class, topick up and return mimeographed copies ofwork prepared by the regular teacher forthe class, to borrow books and learning aidsused by the classroom teacher, and toexchange ideas.

3 Contacts between the child and his classmay be encouraged by means of:a) the installation of home-to-school tele-phone or teaching-by-telephone equipmentto supplement the instruction given by thespecial teacher;b) the exchange of letters, pictures, news-letters, compositions, and so forth, betweenthe homebound or hospitalized pupil andhis classmates;c) visits to the home by classmates, by theclassroom teacher, and by the principal, ona regular basis;d) transferring to the home (on loan) thepupil's school desk and chair;e) brief visits by the handicapped child andhis special teacher to the school before hisactual return; and

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f) long-range competition centred aroundthe mimeographed copies of classroommaterials.

Easing the return to schoolThe home instruction teacher shouldarrange for part-time attendance as soon aspossible, before the pupil is able to copewith full-time attendance. She shouldaccompany the pupil, for reassurance andmoral support, when he returns to schooland encourage him to build self-confidenceand independence.

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Long-term programs

PupilsThese programs are designed for childrenand youths who are chronically ill and maynever return to a regular classroom, andmay never have been in school.

Objectives1 to help the pupil prepare for adult life inaccordance with the best prognosisavailable;

2 to provide realistic vocational and occu-pational guidance and training;

3 to encourage social experiences whereverpossible;

4 to develop satisfying interests and talents;

5 to assist in the adjustment of the pupil andhis parents to the disability;

6 to encourage the pupil to participate in thelife and activities of his family;

7 to stimulate independent thought andactivity;

8 to encourage reasonable standards andevidences of accomplishment withoutfrustration;

9 to build a sense of self-worth and ofsecurity. (His contributions and return to themainstream of society are considerablyless important.)

GoalsThe goals of the program may range all theway from full preparation for post-secondaryeducation to academic training sufficient forrestricted vocational competence or to theacquisition of basic skills for satisfying anduseful leisure-time activities.

ProceduresA thorough, multidisciplinary assessment isbasic to the setting of realistic long-rangegoals and to immediate program planning.Physical capabilities, intellectual potential,medical prognosis, and the possibility ofultimate special placement must be con-sidered in formulating educational plans.

The teacher should plan the child's educa-tional program in the light of his currentcondition, his individual interests, and of hisprobable future possibilities in order tohelp him achieve satisfaction in the present

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and his greatest development in the futuredespite his handicap.

For the academically capable who may beable to achieve higher levels of education,the teacher should seek the co-operationand consent of a local school from whichthe student may officially graduate. Arrange-ments should be made for any desirableadjustments in the requirements forgraduation.

The teacher must consider carefully thewisdom of maintaining close contacts withregular classrooms; it may not always bekind to attempt to do so. In order to widenthe pupil's interest in the outside world, theco-operation of community agencies andspecial interest groups may be enlisted.

For youths at the secondary school level,instruction by subject specialists and extraemphasis on vocational habilitation maybecome necessary. The pupil's independentstudy skills and the use of assignments,materials, and academic experiencesparallel to his age group's regular schoolprograms are important.

Appropriate equipment must be availableon loan typewriter, business machines,shop tools, sewing machine, referencebooks and publications, laboratory kits, andso forth. Two or three subjects at any onetime are recommended. Four subjects maybe offered on a short-term basis.

Each student must be guided toward arealistic view of the total picture; futureproblems need to be anticipated, identified,and solved.

Curriculum SuggestionsEmphasize skills in reading, listening, andcommunicating as much as is appropriateto the individual student. Select academicskills and concepts appropriate to thepupil's age and capabilities. A central themeor problem may be used to correlate varioussubject areas into a meaningful experience.

Music may offer effective avenues forreaching the adolescent pupil. The teachershould aim to know and appreciate a varietyof types of music. She may wish to learn toplay a recorder or to sing.

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Recreational activities should provideopportunities:a) to develop skills, interests, and hobbieswhich make life more meaningful andconstructive;b) for socialization and for physical andemotional development;c) for exposure to movement, color, andtouch games for sensory skills visual andauditory discrimination, recognition ofshapes, auditory and visual memory, spatialrelationships.

The teacher may wish to teach the adoles-cent non-reader to read through lessons intyping. In Lessons One and Two:a) teach the parts of the machine, theirinterrelationship, and the need formeticulous care;b) trace a pair of hands and label for thetouch-typing pattern.

Lesson Three may consist of the followingprocedures:a) random but rhythmic strokingb) sounding letters as they are typedc) experimentation with eye-hand controld) use of space bare) usual lesson 1 words type and read.

In planning a remedial health program, theteacher must take into account the need forregular rest periods, dietary adjustments,capacity to participate, and so forth. Such aprogram should emphasize routine healthhabits and assist the pupil to accept hisphysical limitations, learn to tolerate frus-trations, and understand various reactionstoward handicapped individuals. It shouldalso teach him social skills that help othersto feel comfortable.

In teaching English as a second language,the teacher may involve concurrent teachingof listening, speaking, and reading andwriting (repeating), but should emphasizeoral proficiency. The program should makeuse of phonic games, conversation, role-playing, reports, pictures, charts, flashcards,flannel graph, and other methods andmaterials employed by regular teachers ofEnglish as a second language.

Teaching SuggestionsThe teacher should make use of all the usualaudio-visual aids and instructional aidsfound in regular school programs.

In planning field tr'.)s, the following factorsmust be considered and arrangementsmade accordingly:a) medical directivesb) distancesc) vehicles and modes of transportationd) location of stairs and width of doorse) the accessibility of food and toiletfacilitiesf) noise factorsg) possible emergencies and the effects ofmovement and excitement.

Guest visits may be arranged with theconsent and assistance of the pupil. Theteacher should make sure that such visitsare not made out of a sense of sympathy orduty. Guests may be firemen, a local crafts-man, an author, another homebound orhospitalized pupil, a horticulturist, a workparty of peers involved in a mutual project,a beautician.

In preparing for visits from other children,the teacher should work closely with theparents and plan carefully to avoid over-excitement, fatigue, or tension. Activitiesmay include monopoly, checkers, chess,hobby crafts, and so forth.

If the pupil is ambulatory, a short field tripor a visit to a school for a special occasionsuch as an assembly or a field day may beconsidered.

For homebound pupils who can be trans-ported, a public speaking and/or debatingparty held in the home of one of the pupilsand attended by theft parents and speciallyinvited guests may prove a stimulatingproject.

Programs for pupils with a terminal illness

Objectives1 to enhance the quality of the pupil'slimited life by encouraging social experi-ences wherever possible and developingsatisfying interests and talents;

2 to encourage active participation in thelife and activities of his family and builda sense of security;

3 to stimulate independent thought andactivity and thereby build a sense of self-worth and self-reliance;

4 to provide opportunities for the child andhis parents to deal with their anxiousfeelings openly and constructively;

5 to provide support for members of thefamily and assist them to cope with theinevitability of death.

ProceduresModifications of curriculum will vary withthe interests and ability of the pupil. Thereis no value in being overly concerned aboutparalleling peer-group activities. Anyacademic, recreation, or fun-type activitiesthat are of interest to the pupil and arerealistic in relation to his capabilities shouldbe explored.

It is important to follow medical restrictionsor limitations carefully as the child'scondition changes. The teacher shouldcommunicate regularly with the physicianin charge, the nurse, and the social worker-assigned to the case.

The teacher is in a position to help bothchild and parents to face the crisis of deathand to carry on effectively. Children oftencope with their feelings about death anddying more realistically than adults expect.If they cannot cope with the emotionsroused by a particular crisis, they readilytransfer their feelings onto some lessthreatening situation. The teacher will findit helpful to enlist the assistance of trainedcounsellors (psychologist, theologian, etc.).

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General suggestion

For some pupils, instruction at home or inhospital or a maternity residence may be amost welcome diversion during the summervacation months. Following an acute illnessor during a prolonged confinement, a childor youth will usually welcome at least anhour of daily instruction, which may take theform of active or passive participation, orboth. Assigned study periods, project workor homework (art, research, handicrafts)help to occupy many hours pleasurably. Asenior student may serve as a tutor.

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XXVIInstructional aids

Learning devices and teaching aids are notsufficient in themselves. The teacher mustselect and plan carefully to use each aidwithin a prescribed structure designed topromote directed exploration and growth.Each purchase should be made in the lightof:

a) the conditions necessary for its use;b) its value for the best educational advan-tage of the greatest number of pupils;c) the physical ability of pupils who mayuse it; andd) maneuverability and portability.

1 Home-to-School Telephone ServiceIt is important to remember that this serviceis a supplement to instruction by the hometeacher and not a substitute for it, althoughit may decrease the number of home visitsrequired. It is most suitable for pupils overten years of age and of average, or aboveaverage, intelligence, who are capable ofworking independently without constantsupervision. In all cases, the physician'sapproval is important.

The service involves speaker microphonesin both classroom and home and a privatetelephone line, so that the pupil is able toparticipate in classroom discussions.Evaluation of progress becomes the dualresponsibility of the classroom and thehome-visiting teachers.

2 Tele-classThis service is most effective with studentstwelve years of age or over, of averageintelligence, and independent work habits.Students receive daily instruction. A teacheroperates a conference-type telephone thataccommodates as many as twenty studentsat one time. The students have a singlepurpose instrument to be used only forlessons. The teacher may connect severalstudents for a group discussion while shecontinues a lesson with other students inthe class.

Advantages for the teacher include elim-ination of transportation problems andincreased time for teaching and preparinglessons. One day per week may be setaside for home visiting.

Educational television and prerecordedtapes may become important adjuncts.Computer-to-home via telephone lessons

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may also become practicable in the nearfuture.

3 Tele-Hints (for students and parents)a) Avoid making appointments whichconflict with your class schedule. Whenconflicts cannot be avoided, notify yourteacher in advance.b) Have materials toady, and be preparedto answer the call for each class promptly.When you have answered, stay on the linewhile the rest of the class is being called.If your are accidentally disconnected, hangup so that the teacher may call you back.

c) Make sure you understand assignments;take part in class discussions; askquestions.d) Tele-class requires your whole attention.Background noises in your home willdisturb the entire class.

4 Literature from community agencies andsocieties.

5 Lending facilities of libraries, museums,and art galleries.

6 Television and radio programs (intro-duced and reinforced during instruction).

7 Electronics equipment of high quality andportable size; record.

8 Tape recorders, ear phones, mastertapes, student practice tapes, cartridge-type tapes, amplified head sets, boommicrophones, etc.

9 Films, filmstrips, slides, reverse-screentype projector, ceiling projector, microfilm,etc.

10 Lightweight collapsible overheadprojector, transparencies.

11 Flannel board, display board, abacus,charts, small globe, foldable maps, etc.

12 Supply of pencils, small pencilsharpener, paper, notebooks, take-apartexpendable workbooks, textbooks usedin regular and in special classes.

13 Flash cards, assorted games andpuzzles, basic science kit, manipulativematerials, models, puppets, pictures,counting materials, etc.

14 Auto-instructional machines e.g.,Language Master (Bell and Howell); Learn-ing Systems for Special Education (T.R.

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Services, Toronto); Studyscope (GrantErwin',; Craig Reader (Bank Electronics,Scarborough); E.D.L. equipment.

15 a) Welcome Amigo Manipulativematerials for young children learningEnglish as a second language. Source:Noble ar.d Noble of New York City.b) Language Lotto Source: Appleton-Century Crofts of New York City.c) Mott Basic Language Skills foradolescents learning English as a secondlanguage. Source: Allied Education Councilof Chicago, Illinois.

16 Pictures to accompany materials beingused.

17 Keyboard Town Story TypewritingSystem by A. M. and J. J. Gallagher,published by Follett Publishing Company.This book is designed for slow learners.

18 Language development kits.

19 Perception development kits andprograms.

XXVIIThe pupil

Although most of this publication is con-cerned with organizational problems of theadministrator and the teacher, the mostimportant individual in the programs is thepupil. All suggestions made in this guidelineare intended to reflect the needs and bestinterests of the individual child or youth.Consequently, procedures and programsmust remain subject to change or modifica-tion whenever required for a specific pupiland his physical well being, his socialadjustment, his emotional balance, and hisacademic development.

Educational plans must reflect continuingsensitivity to the realities of the individualchild's psychological needs for security,variety, sense of adequacy and of belong-ing, affection, and orientation or contactwith reality. Whether his confinement is to bebrief or lengthy, a sick child sees himself asdifferent from his former active and healthyself. In his new or current condition, hemay find himself confronted by physicalhandicaps that seriously restrict hisactivities. He may be confined to a proneposition, have one of his senses temporarilyor permanently impaired, suffer a loss ofmanual dexterity, and find himself unable tostudy or to concentrate for even shortperiods. These limitations usually lead toadverse psychological consequences. Thechild is likely to feel disoriented, confused,and frustrated; become easily discouragedand defeated; and see himself as lessworthy and more vulnerable. He may sufferfrom feelings of anxiety or guilt, and byconsequence feel rejected by his family andsegregated from his peers. In the case ofover-protective parents, he may regress toinfantile dependence or be in danger oflearning passive, withdrawn, overlydependent behaviour.

A child who is temporarily or permanentlyhandicapped will need much encourage-ment to learn, or to relearn, skills that areusually acquired spontaneously (e.g.grasping, walking, speaking, maintainingattention, enjoying human association). Hiscondition affects the lives of his entire family

physically, socially, economically, andemotionally and, in turn, is affected by thefamily's attitude toward him, his disability,and his future.

The psychological effects of long-termhospitalization should not be overlooked byparents, teacher, and others whose aim isto assist the pupil in his readjustment.He may have made strong friendships inthe ward, whose loss may make him feeldejected when he returns home. Hemay have formed new insights into theconsequences of his disability, and ofabnormality in general, which may differfrom the views of his parents. He may havesuffered a loss of privacy and of dignity.Close contact with death, pain, and suffer-ing, and observation of a variety of reactionsto confinement and treatment may causehim to challenge family values and patterns.

Whatever the circumstances, the pupil willneed opportunities to release some of hisnegative feelings and scope for self-expression in which to rebuild a self-imageof a worthwhile, identifiable self. He maybe capable of participating (i) at a pre-participation level (i.e., watching others),(ii) at a passive listening level (radio,television, films), (iii) at an assisted activelevel, or (iv) at an active level, but at all ofthese stages he will need a reasonable,consistent, and sustained system ofguidance and discipline within which toformulate reliable guidelines and self-control.

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Appendix

Glossary

aniridia the absence of the iris of the eye

aplasia defective formation or development;lack of development

arthrodesis surgical fixation of a joint

ataxia failure of the muscular coordination;lack of balance

athetotis affliction marked by continuousmovements; involuntary motions

Bell's Palsy facial paralysis

benign not malignant

cerebral palsy a persisting qualitative motordisorder due to a non-progressive damageto the brain

dorsiflexion the act of bending a partbackward

Erb's Palsy paralysis due to degenerativechanges in the spinal cord

Friedreich's Ataxia hereditary ataxia,progressive

glandular fever infectious mononucleosis

histoplasmosis a disease characterized byirregular fever and emaciation; it is due to ayeast-like organism

Hodgkin's Disease of the spleen and lymphnodes; pseudoleukemia

hydrocephaly a condition in which there isexcessive fluid in the head; the head is enlarged;usually associated with low intelligence

incontinence lack of control of bladder orbowels or both

keloid a new growth or tumor of the skin;tends to recur; sometimes tender and painful

Legg-Perthesquiet hip disease in which upperend of femur becomes softened and remains sofor approximately two years. Child's weight mustnot be borne during this time to avoid permanentdisability of hip.

mononucleosis glandular fever

myopia near-sightedness

myositis inflammation of a muscle

Oppenheim's Disease congential myatoniaor spasm of muscles

Osgood-Schlatter's Disease inflammation ofbone cartilage at upper portion of the tibia

Osler's Disease chronic blueness withenlarged spleen and an excess of red corpusclesin the blood

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osteo genesis imperfecta imperfect develop-ment of the bone causing brittleness

perthes see Legg-Perthes

phenylketonuria congenital faulty metabolismoften associated with retardation; PKU

pseudohypertrophy increase of size with lossof function

pyemia pus in the blood stream

retrolental fibroplasia blindness caused bythe use of too much oxygen during a prematureinfant's life in an incubator

spina biloda congenital cleft of the vertebralcolumn with protrusion of the membraneous partof the cord

Still's Disease inflammation of several joihtstogether with enlarged spleen and lymph glands