DESCRIPTORS: special education; psychological, medical and social support, consulting, diagnostics, first-referral appointments, team appointment technology, an integrated help.
SYNOPSIS: The author, vice principal of a unique regional center, describes the activities of this institution and explains its most positive features which help to provide an integrated help to children with special needs and their families.

Providing accessible high quality education implies implementation of an educational environment that would ensure successful socialization of every student including those with special educational needs (SEN) and disabilities.

In Kursk, such a range of services is offered in the Kursk Regional Center for Psychological, Medical and Social Support. The opening of the Center was received with rising hopes both by doctors and teachers.

The Center provides services for the following categories of children:

• with psychological problems including a high degree of pedagogic neglect, who refuse to attend school; with emotional and behavioral disturbance (anxiety, fear, aggression, shyness, etc.); not ready to study; having problem interrelations with parents/guardians, peers, adult strangers;
• with special educational needs (SEN) and disabilities including intellectual disability, speech impairment, emotional disturbance, sensory and orthopedic impairment, and multiple disabilities;
• children who find themselves in difficult life situation including orphans and children left without parental care; children who suffered from various forms of psychological and/or physical violence; children from families of refugees, displaced persons or those who suffered from natural or anthropogenic disasters, etc.

The Center offers the following services to help such children: consulting, diagnostics, pedagogical correction, medical and preventive treatment, parents’ counseling in issues related to family and interpersonal relations, early age developmental problems. The Center also provides counseling and professional support and facilitation to teachers, psychologists, speech pathologists, doctors and social workers who deal with SEN children.

Individually designed programs and current development progress of each child determine course duration for children. The course tempo and qualitative parameters of psychological, social, speech and other rehabilitation are regularly monitored and recorded in registers, evaluation protocols and facilitation charts.

In 2012, we introduced an online system of first-referral applications and electronic reception office.

The Center pays special attention to first-referral appointments with our experts. For instance, a first visit to a psychologist may be made by parents or guardians and also, if necessary, teachers, but without children. This practice is explained by the fact that the expert would like to first listen to what parents (teachers) have to say about the child’s problems, to make a “psychological case history” from the point of view of adults. Such a visit usually lasts about an hour, and the child is invited to a next meeting with an expert who will conduct evaluation and plan further work. And though the prevailing format of pedagogical correction is individual classes, our Center is in constant search of various efficient methods and techniques to deal with each particular child.

For example, if the initial evaluation reveals the necessity to involve two or more specialists of our Center, we try to find the day when these experts work in the shift so they may see the child and parents successively. In more complicated cases, several experts may team together at the same time to conduct a consultation or evaluation.

The experts of our Center have successfully tested new forms of activity: team appointment when four experts (teacher-psychologist, clinical neurologist, speech therapist and clinical psychiatrist) simultaneously receive one client.

Of course, parents mostly request team appointments. Parents are those who determine whether such a council is necessary. However, a team appointment may be also initiated by a specialist of our Center in case the parents have this need but they live in a remote location and have no opportunity to come to Kursk several times, or when there is the need to exclude psychiatric diagnosis. Team appointment is also advisable when the child’s problem is clear and complicated but the parent has failed to formulate the request.

The primary objective of team appointment is to define the amount of necessary help: pedagogical, psychological, diagnostic or medical treatment. The advantage of such a form is obvious. During the visit, the child is accompanied by the mother, so it is easier for the child to adjust to a new environment. While the mother is telling about the reasons of applying to the Center, the child is treated by the speech therapist, neurologist and psychiatrist. The team appointment technology looks like this: the parents and child are invited to the room. They sit close to each other so that they may start interacting to each other in any moment; at the same time both the parent and the child are observed by various experts.

Usually, it is the Center’s speech therapist and/or psychologist who interact with the child: talk to him in order to establish contact and involve him in some playing activity to help the child adjust to the new situation. When dealing with an older child, he is offered to do some drawing. In this case, the child is busy drawing, he responds to adults who address him personally, but he is not closely listening to the conversation between his parents and experts. Simultaneously, our medical personnel, a psychiatrist and a neurologist, deal with the parents. The experts’ task is to identify the main reason why the child is brought to the Center. They also try to understand how the parents view their child’s problem. While learning more about the problem, the experts find out how it appeared and how the child has been developing so far. The experts are able to carry out a multi-aspect evaluation of the child’s psychophysical condition, determine his activity level, psychic tone and many other things.

Thus, there is a whole range of evaluation activities: the doctor compiles the general medical case history, the psychologist examines the nature of the problem from the point of view of psychological development, analyses the validation and adequacy of the parents’ input while observing the child’s behavior at play or other activity. The speech therapist assesses the state of the child’s speech development not only by means of special tests but also listening to the child’s verbal interaction with his parents and other experts. The psychiatrist examines the mother-child interaction, the nature of their relationship.

The team form has revealed the following fact: parents have become less apprehensive of the clinical psychiatrist though there is still a rather strong narrow-minded opinion that the psychiatrist is a doctor for “mentally retarded children”. Not every parent is able to “step over the opinion of friends and neighbors” and apply for psychiatrist’s help. Meanwhile, it is a psychiatrist’s counseling that may solve very serious juvenile problems which used to be fruitlessly handled by neurologists in local outpatient clinics.

Thanks to the team method, the clinical psychiatrist manages to avoid most problems and difficulties of an individual appointment. To conduct an all-inclusive examination in an outpatient or specialized clinic, a psychiatrist assigns consultation of a neurologist, speech therapist, and psychologist. The team method applied in our Center makes it possible to fully solve the problem involving various experts at the same time.

Moreover, the team method allows parents to get not only medication recommendations but also a possible development prediction of the child.

During the closing conversation of the team appointment, the Center’s experts offer the parents clear recommendations on the follow up psychological, pedagogical, medical and social help to the child: medical treatment, possible educational options and strategies, long-term evaluation in the Center and further examination and counseling in various institutions in Kursk Region. The Center also offers optional correction sessions.

This kind of activity has been practiced in the Center since its start. It helps to better and more efficiently evaluate the current situation in the child’s development and understand the roots of the problems as well as determine the most adequate help to the child both within the Center or in other institutions, to recommend the strategy and sequence of the child facilitation in terms of educational route or medical support.

In 2007-2008, the Center introduced a new form of consultation and evaluation service: joint appointment by two experts: clinical neurologist and clinical psychologist, clinical psychiatrist and pedagogical psychologist, teacher-speech therapist and clinical neurologist.

Our experts combine their techniques depending on parents’ demands.

Correction activities of such teams and semi-teams in our Center are determined by the main principle: to provide integrated help at proper place and time depending on the individual condition and development situation of the child’s psychics. It disproves the common practice of “all together, simultaneously, and the more the better.”

The experience shows that most problems the problems come with to an appointment may be solved during the first jointly held consultations. Parents’ apprehensions related to their child’s individual characteristics are often farfetched and do not require specialized treatment. This is usually linked to the fact that parents do not possess enough information, they are pedagogically ignorant or just misled concerning their child’s problems. In this case, the interview may be limited to detailed and clear recommendations.

In future, we are planning to introduce speech therapeutic and orthopedic complexes of biological regional link.

In conclusion, we will emphasize one more time that not just any kind of necessary help to the child may be offered in a medical or educational institution, so the Kursk Regional Center for Psychological, Medical and Social Facilitation – a state-financed (free attendance) institution – may be attractive to most families with children who suffer from various problems.