Support for Children with Special Needs and Their Caregivers

34 Ms Denise Phua Lay Peng asked the Minister for Education in view of the recent death of the twins in Upper Bukit Timah, what lessons can be learnt on the protection of children with special needs and the guidance and support for caregivers, at the national, community and family levels.

35 Ms He Ting Ru asked the Minister for Education (a) how many students are there currently in mainstream schools who have been diagnosed as requiring extra learning support or having special needs; and (b) what additional support has been mandated and available to these students and their families.

36 Mr Ang Wei Neng asked the Minister for Education (a) in the last three years, whether there is an increase in the number of persons with disability, particularly among the student population; and (b) whether the Ministry has plans to improve the support for caregivers of persons with disability.

37 Mr Dennis Tan Lip Fong asked the Minister for Social and Family Development whether the Ministry will strengthen its support for (i) parents and caregivers of children with special needs and (ii) ageing parents who are caring for their grown-up children with special needs.

38 Dr Shahira Abdullah asked the Minister for Social and Family Development what further steps can be taken to ensure that the mental health of caregivers of special needs individuals, children and the elderly are sufficiently supported and that such caregivers will know where to turn to for help.

39 Mr Don Wee asked the Minister for Social and Family Development (a) what measures are in place to reach out to caregivers and promote assistance programmes like respite care through social service agencies; and (b) whether there are interim caregiving services available for highly-stressed families.

The Minister for Education (Mr Chan Chun Sing): Mr Speaker, Sir, may I have your permission to have the next six questions to be taken together by Minister Masagos and myself, please?

Mr Speaker: So, that is Question Nos 34 to 39? Yes, please.

Mr Chan Chun Sing: Mr Speaker, we are all deeply saddened to learn of the deaths of 11-year-old twin brothers Ethan Yap and Aston Yap on 21 January. My MOE colleagues and I mourn their passing and we extend our condolences to their families, friends and schoolmates. I believe all Members of this House will agree with us that the pain hits especially hard, because such young lives have been lost.

Soon after the twins' deaths were made public, the media reported that the boys had special needs. Today, I will not touch on the specifics of this case as it is before the Court, and I urge members of the public not to speculate on the incident or to prematurely draw conclusions on what should be done. But, today, together with Minister for Social and Family Development Minister Masagos, I will address how the Government and all of us can take a whole-of-community approach to provide targeted support to children with special needs and their caregivers across different life stages.

Mr Speaker, Sir, it is our goal for children with special needs to reach their full potential, to be confident in themselves and to be equipped with life skills and values so that they can grow up to lead, as much as possible, as normal, as independent a life as possible.

This starts from the early years, where early detection and timely intervention are critical. Parents are encouraged to refer to the developmental milestones in the Health Promotion Board's Child Health Booklet as reference points and take their children for regular childhood developmental screenings at general practitioners' clinics or polyclinics. If any delay in the child's development is detected, the child will be referred to paediatricians for further diagnosis of developmental concerns. In the preschool, teachers may also flag up children with suspected developmental delays to early intervention professionals, who will work with paediatricians to determine the children's needs. Those children identified to require early intervention, or EI, will be referred to the appropriate EI programmes based on the level of support needed. Depending on the programme, children may receive EI support within their preschools or at EI centres.

For the schooling years, to help parents decide how to best support their children's special educational needs, MOE has collaborated with hospitals, EI centres and special education, or SPED, schools to develop common standards to guide professional assessments and align the recommendations we give to parents. Based on these assessments and recommendations, parents decide whether to enrol their children in a mainstream Primary school or a SPED school. MOE also holds an annual Parent Forum, in collaboration with KK Women's and Children's Hospital and National University Hospital (NUH), to help parents better understand how mainstream and SPED schools can support their children's needs. Parents of children with special educational needs are invited as speakers to share their experiences in choosing a school and working with the school to support their children.

Mr Speaker, Sir, today, some 27,000 students with mild special educational needs attend mainstream schools, supported by teachers who implement inclusive classroom practices and Allied Educators who specialise in learning and behavioural support. Because of their additional needs, some may need pull-out support during or after curriculum time. Those who need additional support in literacy and numeracy join the Learning Support Programmes in English Language and Mathematics in Primary 1 and 2. And those with Dyslexia may join the School-based Dyslexia Remediation programme for Primary 3 and 4. Last year, we announced that we are rolling out the TRANsition Support for InTegration, or TRANSIT programme, for Primary 1 students with social and behavioural needs. Thirty-seven schools have implemented this programme, and more will be coming on board.

When children have higher support needs, professionals will recommend a SPED school because these schools have specialised instruction and customised facilities, specially-trained teachers and Allied Professionals. Currently, approximately 7,000 students, or about 20% of all students reported with special educational needs, attend the existing 22 SPED schools. These students have moderate to severe special needs. Across mainstream and SPED schools, the number of students reported with special educational needs has risen by about 5% in the last three years, largely due to growing awareness and early identification.

Parents are our key partners as they provide valuable insights into their children's unique needs. This is why schools engage families early to find out their children's needs. Schools then provide details of the support available in school and how the school and parents can work together to support their child. When schools and families communicate, they build relationships and share strategies that can be used both in school and at home.

In some cases, parents of children with special educational needs in mainstream schools may find that the mainstream environment does not suit their child. With the advice of MOE Educational Psychologists and the school's teachers and Allied Educators, they may conclude that their child is better supported in a SPED School. MOE also provides Post-Diagnosis Educational Guidance to render emotional support and assistance to parents in the journey towards acceptance of their child's special needs.

In SPED schools, teachers work closely with parents to exchange information on their children's progress and support the application of skills at home and in the community. Each school has a social worker who can help families with additional emotional or financial needs, if needed. Families can access programmes outside of curriculum hours, such as holiday activities and outings run by the schools or Social Service Agencies (SSAs), in collaboration with external organisations and volunteers. There are also Special Student Care Centres, which provide before-and-after school care services for school-going children with special educational needs. SG Enable as well as SSAs also organise parent and sibling engagement activities, including workshops and camps, where participants provide mutual support by sharing experiences and advice.

To help students and families transit from SPED to post-school life, MOE works with the SPED schools to implement school-wide processes of transition planning for students at the Secondary years, where each student has an Individual Transition Plan reflecting his or her post-school interests, strengths and aspirations. MOE also works with MSF, SG Enable and the SPED schools for the School-to-Work Transition Programme, to support work-capable students in transiting from school to work. For SPED graduates who do not transit to employment due to higher needs, MOE works with SPED schools and SG Enable to facilitate their transition to post-school options based on their abilities and needs, including for students identified for MSF-funded services.

Mr Speaker, all parents plan on providing for our children in every possible way until they reach independence as adults. So, we can all understand when parents discover that their child will need a lot more support for a lot longer, even into adulthood. We can experience their heartache, shock and even fear. This is an unplanned journey and can be a challenging one. Many of us know of such families, amongst our friends, relatives or in the community. Some of us are ourselves family of a special person.

I am heartened to hear of families which have drawn strength from circles of support and who have, in turn, given support to others, allowing them to cope with the stress and challenges of journeying alongside their special child.

So, let us do our part to serve as a circle of support for these children and their families. We cannot say, "Let the other neighbour help. Let the other relatives help. Let the other company hire him." We need not wait for one another – let us all take the first step. Let us all let them know that we value them and their children. Let us remind them that they are not alone. When the parents need a break, let us step in to play with or accompany their children. When they seek an understanding employer or colleague, let us be that understanding employer or colleague. Let us be a community that reaches out in both words and deeds to demonstrate care and kindness. Let us be an inclusive society that uplifts one another, leaves no Singaporean behind and moves forward as one.

Mr Speaker, Sir, may I have Mr Masagos make his reply?

Mr Speaker: Yes, please.

The Minister for Social and Family Development (Mr Masagos Zulkifli B M M): Mr Speaker, Sir, may I take Question Nos 37 to 39 together, please?

Mr Speaker: Yes, please.

Mr Masagos Zulkifli B M M: Minister Chan spoke about the support available for children with special needs and their caregivers during the schooling years. I will share more on the support available for caregivers of persons with special needs or disabilities beyond the school setting.

SG Enable was set up in 2013 to support persons with disabilities and is now the single touchpoint for disability and caregiver support services, as well as public education efforts. Caregivers of persons with disabilities who need information to better care for their loved ones and themselves may access the Enabling Guide at www.enablingguide.sg. This is SG Enable's first-stop resource portal for caregivers to learn more about disabilities in general, as well as available disability services, schemes, caregiver training opportunities and informal caregiver support groups. Caregivers of persons with disabilities who need more information on caregiver support services can also contact SG Enable at caregivers@sgenable.sg.

Aside from the Enabling Guide, MSF and SG Enable work with Social Service Agencies to increase awareness of services. Touchpoints occur early as children are diagnosed with special needs at birth or as they develop. This is also the opportunity to begin better equipping caregivers of such young children. For example, SG Enable runs the "Start Right" workshop twice a month to provide information on Early Intervention (EI), the Early Intervention Programme for Infants and Children, or EIPIC, strategies for caregivers to engage their children at home, as well as available community resources and support.

EI centres also provide caregiver engagement and training under EIPIC, so that caregivers are equipped with the skills and knowledge to support their children at home. ECDA is also developing a guide for parents of preschool-age children who require early intervention, arising from a recommendation by the Inclusive Preschool Workgroup to strengthen support for parents. The parents' guide will include information on developmental needs, ways to access EI services, support available to facilitate the child's transition from the preschool years to school-age provisions, as well as self-care strategies and resources. We expect the guide to be ready by April this year.

We want to assure caregivers that they are not alone in providing care for their loved ones. There are various care services that they can tap on. EI centres, as well as many preschools, provide support for children under the age of seven with developmental needs. Special Student Care Centres, or SSCCs, provide before-and-after school care service for children aged seven to 18. Day Activity Centres, or DACs, offer day programmes for adults with disabilities aged 18 and above on either a full-time or part-time basis. Children Disability Homes, or CDHs, and Adult Disability Homes, or ADHs, provide both long-term and short-term residential care services for persons with disabilities.

SG Enable's "Take-A-Break" Pilot Programme provides short-term home-based respite services.

Supporting the mental health and well-being of caregivers is essential to enable them to take good care of their loved ones and themselves. Caregivers who are distressed and need someone to speak to can call the National Care Hotline, the Institute of Mental Health's Mental Health Helpline, or the Samaritans of Singapore (SOS) for support. In addition, MOH and the Agency for Integrated Care (AIC) have worked with Social Service Agencies to set up caregiver community outreach teams, to provide emotional support for caregivers of persons with mental health conditions who have or are at risk of developing mental health needs. Caregivers of seniors and persons with mental health needs can visit the AIC website for information on eldercare services, community mental health services and caregiver support measures, such as financial support schemes and respite care.

MSF has also appointed 10 Parenting Support Providers that offer evidence-based parenting support programmes for parents and caregivers of children. These include the Triple P Programme and Signposts that equip parents and caregivers with strategies to manage the child’s behaviour. MSF's evaluations indicate that attendees reported sustained reductions in parenting stress and improvements in children's behaviour.

Parents and caregivers of children who require low levels of early intervention support and whose children require behavioural support can tap on such programmes as well.

Mr Speaker, supporting caregivers requires many helping hands. It is a whole-of-society effort involving not just the Government, but the community as well. One example is Project 3i, under the SG Together Alliance for Action for Caregivers of Persons with Disabilities, formed by the National Council of Social Service (NCSS) and SG Enable.

Project 3i was started by CaringSG, an organisation set up and led by caregivers, for caregivers. Project 3i aims to strengthen community support for caregivers by connecting caregivers with others in the community, providing befriending and peer mentorship by trained caregivers, and providing caregivers and families with complex needs with advisory support from professional volunteers, including doctors, therapists, teachers and psychologists, to help them better navigate and access mainstream health and social services. We welcome more of such community-led and caregiver-led initiatives.

To all caregivers who are facing the challenges and stressors of taking care of their loved ones, please do reach out if you need any assistance. The caregiving journey can be a stressful one and caregivers need our strong support. In addition to having services and programmes available for them and their loved ones, it is equally important for family, friends and other caregivers to provide emotional support. Let us all play a part by extending a helping hand or a listening ear when we see someone in need.

Mr Speaker: Ms Denise Phua.

Ms Denise Phua Lay Peng (Jalan Besar): I thank the Ministers; very grateful for the heart and hard work that both Ministries have put in. I speak as a disability service provider, a volunteer, a parent of a special needs adult and a parliamentarian. My worry is that the spate of unfortunate events concerning the recent two families will not be the last of it.

Yes, it takes a village – all of us, the Government, disabilities agencies, families, volunteers. We need to take our place and organise better, to get better outcomes. I think when each party thinks that the other party should do it – whether the Government or somebody else – then no one will do it because no one wants to catch the ball alone. It is just too difficult. There are lots of things going on, quite a lot of overlaps, differing standards, noise and so forth.

So, two supplementary questions; I seek the Minister's assurance. One, at the macro level, to share more strategic information, not just when things happen or in Parliamentary settings. Also, involve the ground better.

Strategic information, such as sizing the issue, validating the planning assumptions of the Government Ministries, communicating plans ahead for inputs, ensuring the right partners are onboard and information, such as how many students or adults with special education needs or disabilities are flowing through the system.

And what is the plan? What are the planning assumptions? Where do students go when they exit? What are their prognoses like? How are the current support models, especially in the mainstream schools where the two recent cases are cited? What can be done further to make it more effective? And what are all the immense challenges in the adult disability space?

The issues are really not easy to be settled by just one party: whether it is people, public or private sector. It is all of us.

And then, how can we better tap on, especially train and support ground volunteers, such as those in the grassroots movement? I think there are many of them that have the hearts, but just not so organised, together by us. SG Cares volunteers, even parent groups themselves – how can we involve them and get just better outcomes?

So, that is my first question: how to share more strategic information throughout and involve the ground better?

The second question is, how can we have stronger and more focused work to join the many dots, to peel the onions underneath all the wonderful programmes the Minister listed, to peel the onion further to get to the root causes and then get better outcomes. For example, we need to prevent so many overlaps, so many groups doing the same thing and to ensure better outcomes in not just caregiver support, but also awareness building and so forth.

Hence, I just want to seek the Minister's assurance. I want to thank the Ministries and everybody who has been helping out, for helping out.

Mr Masagos Zulkifli B M M: I thank the Member for her very passionate supplementary questions. Among all of us, we know Ms Denise Phua, and we take a lot of instructions from Ms Denise Phua, from the way we organise and also, to the way we are shaping the disability space. Since I came into Parliament together with Ms Denise Phua, things have actually got so much better. By the time I arrived in MSF, it may look like a mess but it is because more things are being done. And, certainly, coordination must be made.

If it were only the Government, I think it is much easier to organise and coordinate but many helping hands are involved. They are really passionate people. People who are directly involved either as parents or people who really care. We want them to thrive, we want them to progress but we also have to be careful about over-organising them.

In terms of institutional support, we have, for example, special student care centres, we have eight of them. They are mostly in the SPED schools. The question is, do we need more? How can we increase the effectiveness in terms of how we reach out to the parents who need them?

Fortunately, today, since last week, for the longest time that we have been organising, we now have better touch points on the time because we now diagnose the children early, we know who the parents are and, therefore, we can do these touch points earlier. However, there will always be parents whom – because we did not, or during their time, did not have interventions early enough – we may not be able to identify who they are. But we know their families know them, we know their neighbours know them and even when I do house visits, I have met some families who have not been part of our system or did not know that these are available help that they can tap on.

Therefore, I call upon the community, even if we think that no help is being extended to them, or it does not look like help is being extended to them, please reach out to us so that we can do this.

Mr Speaker: Ms He Ting Ru.

Ms He Ting Ru (Sengkang): Thank you, Mr Speaker. My question relates to children who need extra support in schools. I have a few questions. First, how does the Ministry track how these children are doing in school? Secondly, how does the Ministry track how successful these measures of support are? And, finally, are there any proactive steps being taken within a framework, some kind of formal screening available, to identify students who might have learning difficulties or special needs and benefit from these forms of support, and also their families, their parents and their caregivers?

Mr Chan Chun Sing: Mr Speaker, Sir, in response to Ms He Ting Ru's questions, I will just make the following points. The tracking is on a continuous basis. Of course, the tracking is not based on the usual academic standards that we use. Very often, for the students with special education needs, if they are following the mainstream curriculum, then we track their progress. But very importantly, in this progress, we are not trying to measure themselves against other people. As I have always said, for us, it is more important to surpass ourselves than to surpass other people. For many of our children with special needs, the goal is really for them to improve over what they have been able to achieve the previous day, the previous year, to give themselves a sense of confidence, a sense of independence. And that is what, if you like, broadly how we measure our success, in a very broad way.

The second point I would like to make is that we are always in close contact with the parents and the families, so that we can work hand in hand between the school and the families to help progress our children, each according to their potential. Where necessary, we will bring in the education, the professional psychologist to help equip both our teachers with the necessary skill-sets and also the parents with the necessary skill-sets to cope and to care for the children with special needs. So, it is not the kind of usual tracking that we would use for the usual academic yardsticks or performance yardsticks for typical children, but I think for each of the children with special needs, we have to customise the programme according to their needs.

And I would like to make this point that, while we generally use the word "special needs", the special needs community is not homogeneous. Every child with special needs is special in their own ways and they do need different levels of support with different learning needs as well. So, that is why, to add on to what Minister Masagos says, because of the spectrum of needs, we also need a spectrum of solutions in order to best cater to the respective needs.

Mr Speaker: Mr Ang Wei Neng.

Mr Ang Wei Neng (West Coast): Thank you, Mr Speaker. I would like to thank both the Ministers for the very comprehensive replies. MSF has, over the years, issued transport concession cards to persons with disabilities; it has the registry and has been helping them. So, I would like to ask if MSF would consider having a similar registry for the caregivers of persons with disability and proactively reach out to them, either through the Ministries or through the community, so we can all help them?

I echo what our fellow Member, Ms Denise Phua, has said. Many of us want to try to help the caregivers in our respective constituencies, but we also lack resources and the know-how to help them. So, we really hope that the Ministry can come up with programmes and roll them out fast, besides the 3i initiative that we have. We really hope that the Ministry can work with the different segments of society, the population as a whole, so that we can all work together to better prevent this very sad case of a double murder.

Mr Masagos Zulkifli B M M: I thank Mr Ang for the question. The Alliance for Action (AfA) was launched, basically, to get more feedback from caregivers, organisations, parents on what more we need to do. We hope that this will be completed within this year, if not, earlier. And we will take those inputs on board, including the suggestion by the Member, to have a registry. Whether we want to actually do this from the Government, top-down view, my view is that we want to ask the caregivers and see whether this will help them, how it will help them and, at the same time, also have enough protection for their confidentiality, if they want it.

Mr Chan Chun Sing: Mr Speaker, Sir, to pull a few of the threads together, maybe I will just make the following concluding points.

First, I would like to thank all the professionals, teachers, caregivers and families who have extended help to our children with special needs and their families. I know it is very difficult when such an unfortunate incident happens. We will always ask if we could have all done more together to avoid this tragedy. We know that many of our professionals, families, caregivers and volunteers would want to do more.

But deep in our heart, I think we also know that, sometimes, such cases are very hard to prevent altogether. Because it is so hard, I think we are all even more determined to want to do better.

So, the first point is, yes, MOE and MSF, we are regularly reviewing the master plan on how we can provide the continuum of care across the entire life cycle stage, for both the special needs children and their caregivers.

I know that for many of the special needs families, the part that is most challenging, the part that is most worrying for all the families with special needs children is: "what happens when we are no longer around?", "what is the care arrangement, what are the financial arrangements that we need to put in place to take care of our children with special needs?"

And this is where we will double down our efforts to see how we can provide a more seamless continuum, from the school years to the post-school years in terms of care, work arrangements and also financial independence.

Secondly, we would also like to thank all of the volunteers for their efforts to step forward and chip in and, to the extent that we can, both MSF and MOE would like to work with our partners, the volunteers, the caregivers, and we are prepared to try out different ideas, new ideas, to cater to the spectrum of needs that we have discussed in this House. Because we really need a variety of solutions, a variety of know-hows, a variety of resources. Many of these things are very difficult to do because they require staying power, they require us to walk through those dark valleys of life with the person in need and their families. And we really, really give thanks for the many volunteers who have walked this journey.

So, I do not want the volunteers to feel that just because an unfortunate incident has happened, that, somehow, they have not done their part or they have not done enough. I think we also want to affirm the volunteers and professionals who have taken care of our children with special needs and their families as well.