Development and pilot evaluation of a teacher training to support children with developmental disorders in mainstream school settings in Ethiopia

在埃塞俄比亚，严重缺乏针对发育障碍（DD）儿童的服务，包括自闭症谱系障碍（ASD）和智力残疾（ID） （Tekola等人，2016）。围绕DD的耻辱感很高（Tilahun et al., 2016）。至关重要的是，47.1%的看护人参与了一项结构化问卷调查，报告称他们的DD儿童在接受专业支持方面的需求未得到满足（Tilahun et al.,2016）。更高比例（74.5%）的照顾者报告说，他们孩子的教育需求没有得到满足。这一失败被认为是埃塞俄比亚为DD儿童提供服务的最大差距（Tilahun et al.,2016）。最近的埃塞俄比亚教育部门发展计划（埃塞俄比亚联邦民主共和国教育部，2015年）发现，只有4%的有特殊需要的儿童接受了小学教育。虽然该计划报告了到2020年将这一比例提高到75%的愿望，但它也确定了实现这一目标的财政障碍（埃塞俄比亚联邦民主共和国教育部，2015年）。首都亚的斯亚贝巴的两所ASD儿童学校共有120名儿童入学，一些主流学校也有包容性教育计划（Tekola等人，2016年）。然而，由于这些项目的能力较低（Tekola等人，2016年），耻辱感和缺乏教师在特殊需要教育方面的专业知识和培训，大多数患有d的儿童仍然没有上学（Franck & Joshi， 2017年）。考虑到包容性教育，而不是隔离教育，在国际上被认为是DD儿童的一项权利（Lindsay, 2007），并且在埃塞俄比亚得到了教育部的认可（埃塞俄比亚联邦民主共和国教育部，2015），主流学校教师专业知识的增加是特别可取的。亚的斯亚贝巴两所自闭症学校之一的JoyCentre的创始人也发现了培训主流学校教师提供包容性教育的必要性，并开始亲自提供这种教育（Tekola等人，2016），但效果尚未得到正式评估。结合她的经验以及国际文献中的最佳全纳教育实践，一种具有成本效益且易于交付的教师培训可以有助于改善和扩大埃塞俄比亚DD儿童的全纳教育。运用在全球心理健康的几个社会心理干预中成功实施的任务分担方法（Patel et al., 2018），将更多的专业责任转移给专业程度较低的工作人员，将开发可持续的全纳教育模式，包括监督和进修培训。研究目的我提出的研究的主要目的是开发和评估全纳教育的教师培训模式，以支持埃塞俄比亚主流的DD小学儿童。我打算通过三个研究阶段来实现这一目标，每个阶段都有一个单独的目标：A)系统地回顾现有的关于包容性教育干预和教师培训的文献，以支持高、低收入和中等收入国家的DD儿童；B)一项定性探索性研究，以评估教育系统内教师和主要利益相关者在满足埃塞俄比亚DDin学校环境中儿童的需求方面面临的主要挑战以及克服这些挑战的可能方法；（Tilahun et al., 2016）C)基于主流小学教师成本效益高、易于交付的手工培训模式的全纳教育任务分担干预的共同开发、试点和评估，旨在促进对DD儿童的有效支持。

In Ethiopia there is a severe lack of services for children withdevelopmental disorders (DD), including autism spectrumdisorders (ASD) and intellectual disabilities (ID) (Tekola et al.,2016). Stigma surrounding DD is high (Tilahun et al., 2016).Critically, 47.1% of caregivers who took part in a structuredquestionnaire survey reported unmet needs in receivingprofessional support for their children with DD (Tilahun et al.,2016). An even higher proportion, 74.5% of caregivers,reported that their children's educational needs were unmet.This failure has been identified as the largest gap in serviceprovision for children with DD in Ethiopia (Tilahun et al.,2016). The most recent Ethiopian Education SectorDevelopment Programme (Federal Democratic Republic ofEthiopia Ministry of Education, 2015) found that primaryschool education was provided to only 4% of children withspecial needs. While the programme reported an aspirationto increase this proportion to 75% by 2020, it also identifiedfinancial barriers to the achievement of this goal (FederalDemocratic Republic of Ethiopia Ministry of Education, 2015).A total of 120 children are enrolled in two schools for childrenwith ASD in the capital city, Addis Ababa, and inclusive9 / 12education programmes are present in some mainstreamschools (Tekola et al., 2016). However, most children with DDremain unschooled, because of low capacity of theseprogrammes (Tekola et al., 2016), stigma and lack ofteachers' expertise and training in special needs education(Franck & Joshi, 2017). An increase in teachers' expertise inmainstream schools is particularly desirable, considering thatinclusive education, as opposed to segregated education,has internationally been recognised as a right for childrenwith DD (Lindsay, 2007) and is endorsed in Ethiopia by theMinistry of Education (Federal Democratic Republic ofEthiopia Ministry of Education, 2015). The founder of the JoyCentre, one of the two autism schools in Addis Ababa, hasalso identified a need for training teachers in mainstreamschools to provide inclusive education and started providingthis personally (Tekola et al., 2016), but the effects have notbeen formally assessed. A cost-effective, easily-deliveredmanualised teacher-training incorporating her experience, aswell as best inclusive education practice from theinternational literature, can contribute to improving andexpanding inclusive education for children with DD inEthiopia. Applying the task-sharing approach successfullyimplemented in several psychosocial interventions in GlobalMental Health (Patel et al., 2018) in which more specialistresponsibilities are transferred to less-specialised staff, asustainable inclusive education model will be developed,including supervision and refresher training.Research aimsThe main aim of my proposed research is to develop andevaluate a teacher training model of inclusive education tosupport mainstream primary-school children with DD inEthiopia. I intend to achieve this through three researchphases, each with an individual aim:A) A systematic review of the existing literature on inclusiveeducation interventions and teacher trainings to support tochildren with DD in high, low and middle income countries;B) A qualitative exploratory study to assess the mainchallenges faced by teachers and key stakeholders within theeducational system in meeting the needs of children with DDin school settings in Ethiopia and the possible ways toovercome them; educational needs identified by caregivershave previously been investigated (Tilahun et al., 2016)C) The co-development, piloting and evaluation of aninclusive education task-sharing intervention based on acost-effective and easily-delivered manualised training modelof mainstream primary-school teachers aimed to promoteeffective support to children with DD.