Inclusive and Supportive Education Congress International Special Education Conference Inclusion: Celebrating Diversity? 1st - 4th August 2005. Glasgow, Scotland

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The experience of the educational center for the hearing
impaired individual, in Bauru/SP/Brazil  

MSc Maria José   Monteiro Benjamin Buffa
University of São Paulo, Hospital for Rehabilitation of Craniofacial Anomalies
zeze@centrinho.usp.br

            The   Hospital for Rehabilitation of Craniofacial Anomalies – HRAC, of University of São Paulo – USP, Bauru Campus, with the support of the Foundation for Study and Treatment of Craniofacial Deformities – FUNCRAF, assists patients with cleft lip and/or palate, craniofacial anomalies, syndromes, other associated alterations, hearing and visual impairment. In the hearing area, it maintains 4 specialized centers, each one with its own specificity according to the public assisted. The examination includes diagnosis of hearing impairment and fitting of electronic devices for educational and/or therapeutic (re)habilitation. In this article, we intend to emphasize the treatment of (re)habilitation offered at the Educational Center for the Hearing Impaired Individual – CEDAU.

            CEDAU has, as main parameters of its action lines, the principles of the auditory-oral approach, which intends to give priority to the treatment of the primary disability of the child: the hearing.

            According to Bevilacqua & Formigoni (1997), the aim of this approach is to help the child to use the residual hearing and therefore grow up learning to hear and speak in a way to expand the knowledge and life experiences and become integrated and participant in society.

            This study addresses the child with sensorineural hearing deficiency, without other problems, and users of hearing aids (HA) or cochlear implants (IC).

            The age to go into this program is the youngest as possible and, in some cases of advanced aging, children pass through a detailed evaluation for identification of hearing abilities, oral communication and comprehension, besides the level of interest of the family. It is important that the child lives in Bauru or in this region, so as to allow assiduous participation in the (re)habilitation work.

            Until approximately two years of age, the child performs two individual sessions, twice a week, with speech therapists or psychologists together with the mother and/or the father, which can occur in a demonstration house called Casa Caracol* or in other environments of CEDAU. At this stage, the habilitation emphasizes more the action of the family in the therapeutic process, with development of educational strategies directed towards hearing and oral language, besides family counseling. The family is the “modifying agent of reality” of the child. The therapists work as “supporting agents” (Bevilacqua, 1985).

            When completing two years of age, the child begins to expand the relationships with other children and other partners besides the parents, which allows the participation in group activities. They start to attend CEDAU from Monday to Friday, during the mornings, and the examinations are more intense and systematic. The groups vary from three to six children and are conducted by skilled pedagogues in the area of   hearing impairment.

            The group favors a very rich work of oral language, by activities of life experiences (daily life activities, strolls, dramatizations, etc.), besides the activities with pre-established and spontaneous themes, aiming at the development of hearing and language.

            Some criteria are observed for the setting of groups: age, hearing abilities, communication abilities, level of interest and development of the child, as well as social and emotional behavior. We intend to form the most homogeneous groups as possible, but difficulties occur, and it is necessary to have flexibility and constantly evaluate its working dynamics, to make the necessary adjustments to achieve success in this work.

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* The Caracol House is a house adequately equipped (with room , kitchen , living room and bathroom ), targeted to reproduce situations of daily life, in which the hearing impaired child , family and therapist experience daily life by means of techniques and strategies to facilitate integration with the sound world ).

            For school-aged children, besides the work   previously mentioned,   activities turned to writing are proposed, which intend to favor the process of construction, acquisition and development of abilities of reading and writing, leading them to assume a more positive position towards the Portuguese language in this modality of expression. Being more inclined and stimulated, they can reach more advanced levels of knowledge and, therefore, higher levels of scholarship (Buffa & Godoy, 1998).

            Associated to group care, individual speech therapy sessions are offered twice a week, to therapeutically meet the specific needs of each child. Review of the HA and IC, ear molds, and adaptation of modulated frequency devices – FM (sound amplification device used in the classroom) are constant activities of the speech therapist.

            Another important area in the process of (re)habilitation is the psychology. “The therapeutic proposal for a more adequate work for the hearing impaired individual should be well established in a speech therapeutic clinical model, but must also be associated to other fundamentals of clinical audiology, and especially to the areas of knowledge related to the theory of education and psychology” (Bevilacqua & Formigoni, 1997). Examination in this area occurs individually, paying attention mostly to the emotional aspects, according to the need of each child. The family is also the focus of attention of psychology in this process, because, according to the same authors, as much as the family is involved and adequate, the best prognosis the child will have.

            With this concern, in 1998, the Integrarte program was established at CEDAU, destined to mothers of children. The program is conducted by a psychologist and is offered daily; mothers voluntarily participate in the group and develop hand works, express feelings, exchange experiences, integrate with the others, the children and with the staff. The moment is very rich for psychological intervention.

            Still concerning the care of families, a group of parents meet monthly, in which fathers and/or mothers and a professional of each area of CEDAU take part with counseling activities and orientations, interpersonal relationships, and valorization of self-esteem. The experience with this group has been extremely positive, while we realize the transformations of the family in the process of (re)habilitation of their children.

            The Social Service is also part of the staff, orienting, counseling and accompanying the social issues, allowing the repairs of HA and providing home visits. Most families belong to a low socio-economic class, which demands special attention.

            Referral of the patients is a constant activity within the process. Children are referred to other centers from the same Institution: the Center for Care of Hearing, Speech and Visual Disturbances – (CEDALVI) or the Center for Hearing Investigations (CPA) for medical consultation, exams, evaluations, impressions, fitting of HA, etc., and to the Dental Clinic for consultation and attendance.

            Thinking on the global education of the child, the HRAC-USP offers snacks, lunch or dinner, which besides the nutritional aspect, have the therapeutic aim at the development of hearing and language. It also offers transportation (with the support of the City Hall of Bauru) to assure the assiduity of the child.

            One of the principles of the auditory-oral approach is to insert the child in regular teaching, to allow greater hearing experiences provided by the intimacy with children capable of hearing. Therefore, in the period opposite to that attending CEDAU, the 25 children of this Center attend regular school. Trying to minimize the difficulties faced by the child and the teacher, the staff visits the schools and develops a Training Program for educators.

Training Program for educators

            With the objective of offering a technical cooperation service to the state, municipal and private schools of Bauru and region, the program tries to give instruments to the school staff in a way to help the process of learning and teaching of the hearing impaired child.

            The guarantee of the educators’ presence in the classrooms happens by means of an informal partnership with the Directory of State Teaching and the City Secretary of Education, which call their teachers to participate. Private schools are invited and take part effectively. The classes occur at HRAC-USP itself, monthly (from March to June), with the duration of eight hours, adding up to thirty-two hours.

            The themes addressed in the classes refer to Basic Concepts about hearing impairment; Hearing Aids (HA, FM, IC); Reading and writing in the education of hearing impaired children; Organizational structure of CEDAU; Educational and Social inclusion; Curricular adaptations and evaluation process; The teacher and student relationship in the teaching-learning process; Family feelings and statements of hearing impaired adults.

            The Training Program was initiated in 1993, shyly, aiming at meeting the needs of 20 teachers of children at CEDAU; however, with the movement of inclusion, the number of participants grew each year, so that nowadays it involves 7 state schools, 7 municipal schools, and 7 private schools, amounting to 56 participating educators. This is the average of the last years.

            At the end of last year, an evaluation was performed with the participating teachers, in which 84.09% recommend the course to other teachers, and 15.91% did not answer.

            By the statements, it can be noticed that the teachers are changing their point of view, in relation to the care to the hearing impaired child in the classroom:

            “With this training course I am looking at hearing impaired children with a different point of view and with the interest to help them”.

            “The approached content was very valuable, because today I am no longer scared with the inclusion of hearing impaired children; it also gave me a wider view to evaluate these children and alternatives to work with them”.

            “This work is very important, because it solves the doubts of teachers who work with hearing impaired individuals and do not have real knowledge on the situation”.

            Besides these classes, the Program includes visits of professionals to schools, offering specialized technical cooperation to the school staff, keeping a work between Institution and School; this way, we believe that inclusion of hearing impaired children will be favored; consequently, their global development will be able to reach its plenitude.

            All work developed in these years has multiple meanings and emotions and has presented meaningful results, featuring the CEDAU Choir, in which children sing and enchant in presentations in internal festivities, as well as in the community.

              Despite the differences and valorization of potentialities of hearing impaired individuals, they were the axis that led and still leads the work of the staff which, in a permanent learning, become capable to transform crises in opportunities to grow, build and rebuild, reflecting in the action and in the happening on behalf of these children and families which searched, trusted and trust in the (re)habilitation.

            Thus, CEDAU offers a complete and interdisciplinary work, essential in the attendance to the hearing impaired individual. This is not true for the whole country, where many are still excluded by the lack of opportunities and serious and effective integral rehabilitation programs.

References

• BEVILACQUA, M.C., FORMIGONI, G.M.P.   Audiologia educacional: uma opção terapêutica para a criança deficiente auditiva. Carapicuíba: Pró-Fono, 1997

• BUFFA, M.J.M.B., GODOY, L.A.F.G. habilitação/educação/inclusão: experiência         

      no CEDAU. In: SEMINÁRIO NACIONAL DO INES, 3., 1998, Rio de Janeiro.   

     Anais... Rio de Janeiro: Sindicato Nacional de Livros, 1998. p.140-145.

3.     BUFFA, M.J.M.B. Propostas terapêuticas e/ou educacionais para (re)habilitação na área da deficiência auditiva e capacitação de educadores. Espaço: informativo do INES. nº 16 (julho/dezembro 2001)- Rio de Janeiro : INES,2001.

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