Following is a question by Dr Hon Elizabeth Quat and a written reply by the Secretary for Education, Mr Kevin Yeung, in the Legislative Council today (January 30):

Question:

     Children with special educational needs (SEN) refer to children with the following conditions: specific learning difficulties, attention deficit/hyperactivity disorder, autism spectrum disorders, speech and language impairment, intellectual disability, hearing impairment, physical disability, visual impairment and mental illness. Regarding the support for children with SEN, will the Government inform this Council:

(1) of the respective numbers of children referred to the Child Assessment Centres (CACs) under the Department of Health (DH) for assessments in each of the past five years by (i) clinics under the DH, (ii) the Hospital Authority (HA), (iii) the Social Welfare Department (SWD) and (iv) the Education Bureau (EDB);

(2) given that at present, children with physical, developmental, behavioural or learning problems are first referred to the Maternal and Child Health Centres of their respective districts for assessment, are then referred, on a need basis, to the CACs for assessment, and are subsequently referred, on a need basis, to the HA for specialty consultation, whether the Government has assessed if the process is too complicated and can be streamlined so as to facilitate early identification of children with SEN and follow up their needs; if it has, of the details; if not, the reasons for that;

(3) given that the "On-site Pre-school Rehabilitation Services" and the "Training Subsidy Programme for Children on the Waiting List of Subvented Pre-school Rehabilitation Services" target at children with SEN who are aged below six, whether the Government will relax the age ceiling so that such children can continue to receive support upon admission to Primary One; if so, of the details; if not, the reasons for that;

(4) given that starting from the current school year, pre-school rehabilitation service units will, before school year begins, forward to the EDB through the SWD the progress reports of children with SEN who are of the right age for admission to Primary One, so that the EDB can transfer the relevant information to the primary schools concerned before the commencement of the school year, whether the Government has (i) received complaints about this arrangement, and (ii) assessed the effectiveness of the arrangement; if so, of the details;

(5) given that under the integrated education policy, children with SEN will attend mainstream schools, and schools will support students facing varying degrees of learning difficulties according to the "3-Tier Support Model", but there are views that school-based support measures cannot provide support according to the actual situation of individual students, whether the Government will introduce measures which better cater for the individual needs of students; if so, of the details; if not, the reasons for that; and

(6) whether it will consider afresh (i) compiling statistics on the number of children waiting for SEN assessment each year as well as their waiting time, and (ii) setting up a central database for children with SEN to facilitate stakeholders to grasp the demand for services to support children with SEN; if so, of the details; if not, the reasons for that?

Reply:

President,

     Through multi-disciplinary collaborative efforts, relevant government bureaux/departments have been offering various services to support children with special needs or at risk of developmental delay.Specifically, the Food and Health Bureau (FHB) provides assessment and medical services for children in need, while the Labour and Welfare Bureau (LWB) provides rehabilitation and welfare services. The Education Bureau (EDB) is responsible for providing public sector ordinary schools with various additional resources, professional support and teacher training to help them cater for students with special educational needs (SEN). By providing training for teachers, teachers' professional capacity can be enhanced so that they can identify and provide appropriate support for children with special needs as early as possible.

     Our consolidated reply, prepared in consultation with relevant bureaux and departments, to the question of Dr Hon Elizabeth Quat is as follows:

(1) The Child Assessment Service (CAS) of the Department of Health conducts clinical assessment for children under the age of 12 years with suspected symptoms of developmental problems referred by doctors or psychologists. New cases are referred from various channels, including the Maternal and Child Health Centres (MCHCs), the Hospital Authority (HA), doctors in private practice and psychologists. In the past five years, the number of new cases referred to the CAS from various sources is as follows:
 

	Number of cases
Channels of referral	2014	2015	2016	2017	2018 (Provisional)
The MCHCs and other specialties under the DH	5 731	6 328	6 554	6 812	7 155
Paediatricians, Out-Patient Clinics and other specialties under the HA	1 344	1 368	1 416	1 422	1 233
Doctors in private practice	1 844	1 652	1 611	1 533	1 442
Psychologists (including those from the HA, EDB, SWD, non-governmental organisations and in private practice)	548	505	600	655	630
Others	27	19	7	16	6
Total	9 494	9 872	10 188	10 438	10 466

(2) The MCHCs under the DH provide a comprehensive range of health promotion and disease prevention services for children from birth to five years of age through the Integrated Child Health and Development Programme which covers developmental surveillance.  Through developmental surveillance, healthcare staff of the MCHCs arrange interviews with parents at specific ages of the children and observations of their performance in various developmental areas for early identification of children suspected to have developmental disorder. Apart from the scheduled visits at specific ages, parents can always make appointments with the MCHCs for special follow-up. In addition, under the Comprehensive Child Development Service jointly implemented by the EDB, DH, HA, SWD and non-governmental organisations, pre-school tutors can directly refer children in need to MCHCs of respective districts for preliminary assessment. Subject to assessment results and needs, the MCHCs may refer children to assessment services of the DH or other specialist services of the HA for follow-up. The waiting time for assessments by doctors at the MCHCs generally ranges from four to eight weeks. DH will continue to monitor the service demand and make internal manpower deployment as needed to ensure timely case referral.

(3) On pre-school rehabilitation services, the SWD provides children with special needs from birth to six years of age with early intervention services to enhance their physical, psychological and social development, thereby improving their opportunities for admission to ordinary schools and participation in daily activities, and helping their families to meet their special needs. These services include the On-site Pre-school Rehabilitation Services and the Training Subsidy Programme for Children on the Waiting List of Subvented Pre-school Rehabilitation Services.

     When pre-school children with special needs progress to Primary One, they need to be given various learning support, accommodations and guidance in order to adapt to learning in primary schools which have different requirements in learning, social, emotional and behavioural aspects as compared with those in pre-school stage. Hence, on top of regular subvention, the EDB has been providing public sector ordinary schools with additional resources, professional support and teacher training to assist schools in catering for students (including Primary One students) with SEN so as to enhance their learning effectiveness.  Starting from the 2018/19 school year, the EDB, SWD, HA and DH have strengthened their collaboration and introduced an enhanced mechanism under which the assessment information and progress reports of pre-school children with special needs will be transferred to the primary schools they are going to attend before the new school year begins. This enables schools to learn about the SEN of these children so as to plan and provide appropriate support for them. In parallel, the EDB has all along requested primary schools to implement the "Early Identification and Intervention Programme for Primary One Students with Learning Difficulties" to ensure that students who have received pre-school rehabilitation services can receive further assessment when necessary as well as early support, and also to ensure that students not identified at pre-school stage can be identified and given appropriate support. The EDB will continue to support Primary One students with SEN under the current mode of service.

(4) Starting from the 2018/19 school year, the EDB, SWD, DH and HA have strengthened collaboration and implemented an enhanced mechanism to ensure that when children with special needs proceed to primary schools from pre-school centres/kindergartens, the primary schools can be aware of their special needs earlier and provide them with support.

     Under this mechanism, for each school year, the EDB will send letters and parental consent forms to parents of children who are receiving or waiting for pre-school rehabilitation services subvented by the SWD, and are of the right age for admission to Primary One the next school year. Upon obtaining parental consent, the EDB will send the relevant children information to the Child Assessment Centres (CACs) of the DH and HA so that the CACs will provide the assessment information of these children to the EDB. In June, the EDB will confirm with parents the schools which their children are going to attend, i.e. public sector primary schools or Direct Subsidy Scheme (DSS) primary schools, for transfer of the assessment information to the schools concerned before the new school year begins. This enables schools to learn about the situations of these students as early as possible with a view to planning and providing appropriate support for them.

     Besides, upon obtaining parental consent, the pre-school rehabilitation service units subvented by the SWD will also forward, via the SWD, progress reports of pre-school children to the EDB for transfer to the public sector or DSS primary schools which the children are going to attend before the new school year begins. Professional officers of the EDB will visit the primary schools concerned within the first six to eight weeks upon the commencement of a new school year to understand from the primary schools their support services for the respective Primary One students based on the assessment information from the CACs and progress reports from pre-school rehabilitation units, and will offer advice to schools as appropriate. The enhanced collaborative mechanism, implemented from the current school year, has been running smoothly and we have not received any complaints. We will continue to review the implementation of this enhanced mechanism.

(5) The EDB encourages schools to adopt the Whole School Approach to support students with SEN through the 3-Tier Intervention Model, taking into account their individual circumstances and support needs. Tier-1 support refers to the use of quality teaching in the regular classroom to cater early the diverse learning and adjustment needs of all students, as well as to provide early support to students identified with learning difficulties and adjustment problems. Tier-2 support is additional support, such as after-school small group training, for students to develop learning and/or social-adaptive skills required for regular classroom learning or daily living. Through practice and application in regular classroom, students' acquisition of knowledge and skills under Tier-2 support can be strengthened. Schools will provide Tier-3 support to students with severe and persistent learning difficulties by setting out individualised support and small group training through devising Individual Education Plans (IEP), and by providing opportunities for students to practise and apply the knowledge and skills acquired in Tier-2 and/or Tier-3 support in the classroom, thus ensuring the effectiveness of the overall support.

     The above-mentioned 3-Tier Intervention Model is underpinned by the Response to Intervention (RTI) approach. The determination of the tier of support for individual students with SEN through the RTI approach is rooted in the consultancy report that the British scholar Dr Rea Reason prepared for the then Education and Manpower Bureau. In the report, Dr Reason suggested that Hong Kong should, drawing on the experience of the United States of America and the United Kingdom, arrange timely and structured intervention for the students, adjust the tier of support according to RTI and review the progress of students regularly in order to evaluate and provide the appropriate tier of support for students under the 3-Tier Intervention Model. The arrangement enables students with diverse needs to receive the most appropriate support and services.

     To provide the appropriate tier of support that matches the needs of students with SEN, student support teams of schools will collect and analyse their students' information and needs, gauge the views of students and parents, and consult professionals. Schools are also required to record the support and accommodation measures provided, as well as their students' progress for regular review and adjustment of the tier of support when appropriate. For students who need Tier-3 support, schools must draw up for each of them an IEP which sets out such items as long-term objectives, short-term objectives, specific implementation methods, evaluation criteria and outcomes. Underlying the above measures is the principle of catering for the individual needs of students. We will continue to monitor the effectiveness of these measures and introduce enhancement measures.
 
     From the 2019/20 school year, we will implement various enhanced measures on integrated education including restructuring various funding schemes on integrated education, extending the Learning Support Grant, multiplying the grant rate for Tier-3 support and provision of additional permanent teaching posts; upgrading the post of special educational needs coordinator to a promotion rank in public sector ordinary schools with a comparatively large number of students with SEN; extending further the Enhanced School-based Educational Psychology Service; and enhancing the school-based speech therapy services. On the whole, schools will have a stable teaching force, resources that can be used flexibly and enhanced professional support to cater for students with SEN.

(6) (i) The DH and the HA have expressed that they will continue to maintain close communication with various service providers, with a view to providing more appropriate and effective medical services for the children with SEN.

(ii) At present, there is an established collaborative mechanism in place among the EDB, SWD, DH and HA to ensure that the assessment information and progress reports of pre-school children with special needs will be transferred in a timely manner to the primary schools they will be attending, thereby enabling their schools to provide appropriate support for them upon their admission to Primary One. The Special Education Management Information System (SEMIS) of the EDB also collects the information of students with SEN studying in public sector schools. The EDB has been keeping tabs on the situation of the demand from students with SEN for educational services and support through the information collected by SEMIS, so as to implement corresponding policies and measures to assist public sector schools in supporting these students. Different bureaux and departments can, upon parental consent, transfer the information of children with special needs. Hence, we have no plans to set up a central database for children with SEN at this stage.

Ends/Wednesday, January 30, 2019
Issued at HKT 17:16

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