Comenius 1.2 Multilateral Project 2008-10
Contract number 142084-2008-LLP-BE-COMENIUS-CMP 2008-2010

www.daffodilproject.org

Assessment of children in special needs in Sweden

Petri Partanen, lic. psychologist, Skolutvecklarna Sverige, Sweden

Vivianne Mattsson, spec. educ. Teacher, Elevhälsan Östersund, Sweden

Solveig Westerlund, lic. psychologist, Elevhälsan Östersund, Sweden

Report made for Assessment re-assessed: Current Assessment Practice in Europe: weaknesses, strengths and needs. In what way does assessment favour or inhibit inclusive education?

Introduction

Legislation on children in special needs in educational context

The major law that supports the rights of children in special needs during childhood is the school law that is applicable for all children in preschool and school. Children also have the right to attend preschool from 1 years age, and even before if there are special needs (Skollagen). The school law also states that children in special needs have the right to adjustments and support according to their needs. The needs are to be assessed by those professionals that the municipality or principal in charge thinks have expertise, and the principal in charge has this responsibility and authority according to the regulations for compulsory school (Grundskoleförordningen). This means that the professionals involved in an assessment may vary between municipalities. The new proposition for the school law (in preparation for 2011) may postulate exactly what professionals the municipalities have to use. Today only the medical branch, school nurses and doctors are obligatory staff.

Accordingly the medical branch of the school health services has a legislative responsibility to follow the physical and psychic development of children from 6 years up to 18 years age, to the end of upper secondary school.

There are a number of other laws that are adjacent to the school law, although they have not formal authority in relation to the school system. From the social services a child in risk due to social circumstances may be assessed with the support of the social services law (Socialtjänstlagen) and recommendations for treatment, social interventions in family as well as recommendations for interventions in school may follow.

Children with diagnoses of mental retardation and autism-spectrum disorders have legislative rights for special support during leisure time, based on their individual needs. This is formulated in the laws for disabled persons (LSS, LASS).

Organisation of assessment

In Sweden assessment of children in special needs is undertaken at different occasions by different organisations and institutions. The major actors in this area are four institutions: (1) the public child and family clinics (BVC) responsible for regular health controls and early detection during early childhood 0-5 years across the whole population, (2) the child and youth habilitation services (BUH) responsible for diagnosing, treating and assisting children with congenital or early-acquired permanent disabilities, a specialist institution with 0-20 agespan, (3) the child and youth psychiatric units or clinics (BUP) working with children with psychiatric needs, also a specialist institution working from 0-18 age span, and finally (4) the school health services following and supporting the learning and development of all children in preschool and school. The three first institutions are tax-funded public institutions organised by county councils in the regular clinical healthcare system, free of charge. The school health and student services, also tax funded and free of charge, are organised by the municipalities and often managed as part of the preschool and school organisation.

Assessment is undertaken by these different institutions depending on when and where the concerns regarding the child’s development grows strong. It may be the parents or the nurse raising the issue at a regular health control, preschool teachers or teachers bringing up the topic of a child’s learning and development, it may be an accident at early ages leading to a early-acquired disability or a congenital disability diagnosed during pregnancy.


In the health care system the main goal of assessment is to formally diagnose the child in order to prescribe treatment. Assessment also has consequences on decisions regarding resources (financial support for personal assistance in the family, access to therapies etc.).

In the educational system in Sweden an important goal of assessment is to raise the knowledge of parents and teachers of the needs of the child, in order to make adjustments in the learning environment, rather than to formally diagnose a child. This is also regulated in the laws and the curriculum of the school system: the child has the right to adjustments and support in regular school according to its functioning and needs rather than according to formal diagnoses. This is stressed by many policy makers in the different municipalities across Sweden.

Assessment as part of formal placing to different school forms, as well as compulsory assessment of all 6-year-old children with “school maturity tests” is no longer part of the Swedish school system. From 1950´s segregating national curriculum to 1980´s and 1990´s national curricula, a more inclusive approach emerged. Earlier, school psychologists were involved in using assessment as gate keeping and sorting to special education clinics. Today assessment as part of recommending children to special schools is limited primarily to children with the diagnoses of mental retardation. Even in these cases the parents are responsible of the final decision of placement of the child, and in many cases the child may be integrated into regular school, but with extra support. Thus, the Swedish school system and it laws has been developing in the direction of inclusive education. However small special educational groups integrated in schools are quite common, and exclusion appears rather in a small local format than in a state-sanctioned format. The differences between municipalities are big, and local policy makers and school managers often have the possibility to adopt their own philosophy regarding inclusion and exclusion, as well as how special education is to be defined in theory as well as practice (Persson, Nilholm & Björk-Åkesson).

Although a movement towards inclusion and a common concept of “a school for all”, assessment and diagnosis of children with the diagnosis of mental retardation and neuropsychiatric diagnoses has increased in Sweden the last twenty years. It has also led to a growing number of local special educational groups and units for children with neuropsychiatric diagnoses. This development has been under public and professional debate among scientists from different fields like medicine, sociology and educational research as well as among health care and school professionals (Säljö & Hjörne, Snaprud).

In this report we intend to describe the current situation from a local and national perspective in Sweden and discuss the main dilemmas regarding assessment as experienced by professionals in the health care system, school system and parents.

Method

The general questions under investigation were generated in dialogue with participants in the Daffodil project (see appendix 1).

In different countries in EU the preconditions for assessment, the professionals involved, as well as the legislative aspects differ. Therefore we chose to adapt the questionnaire and the data gathering method to local and national circumstances.

Data gathering and analysis was conducted in following steps:

(1)  We made qualitative semi-structured interviews with 5 parents and 3 teachers that had been part of psychological and/or special educational assessments in the school system in one municipality. Being part of an assessment is a delicate experience for both parents and teachers. Therefore, we chose a qualitative method because it could give us in depth reflections from the interview persons about their subjective experiences of being part of an assessment process. The selection of assessment cases were done through a randomized selection from a number of assessments done between 2006-2008. The number of interviews is of course too small to make inferences about regular trends in assessment in Sweden, but was enough to form hypotheses for further investigation and method development.

(2)  A survey in form of a questionnaire was also sent to 5 external institutions and organisations working with assessment: three clinics in the health care system in the regional county council, and two school and student health services in major metropolitan areas across Sweden. Thus the study involved organisations working in more sparsely populated areas (pop -50000 inhabitants) and metropolitan areas (pop. over 500000).

(3)  After the interviews and the survey the personnel from the school and student health service at the local municipality formed focus groups consisting of 3-4 persons, altogether 4 focus groups. The personnel consisted of educational psychologists, special education teachers and the school doctor. They read the transcripts from the interviews and analysed them at two occasions. The focus groups presented their results and a process protocol was written during this presentation. A number of dilemmas regarding assessment practice were identified and formulated in this process protocol. This third step was not only data-gathering but also analysis and discussion of results. The participants in the focus groups could compare their own experiences and analyse and discuss the results in depth.

Results

Interviews with parents

1. What was the overall benefit from the assessment?

In this area parents give a dual answer. Three parents describe on one hand that when assessment focused on reading and writing, the assessment has lead to positive change and progress:

“After the assessment a lot has happened. Earlier he had a tough time at school - he didn’t understand and was a so called “problem child”. Now he is one of the calmest in the class, a totally different child. Now he is able to read and to write. In addition his self-confidence has increased a lot”

Two parents on the other hand expressed that the psychological assessments did not lead to a substantial benefit. Although the assessments gave them more knowledge, there was no-one at the school that took responsibility for an individualised educational planning:

“There was no local special education teacher at the school and there was a change of principal at the time. There was no one who could take responsibility of the educational planning after the assessment.”

2. Did you experience dilemmas or problems related to the assessment?

The themes evolving in this issue are in two cases concerned with the need of early detection and early intervention:

“Could this not have been discovered earlier? We felt that year 2 and 3 passed and no-one said nothing [about the childs difficulties]”

In another case parents express that the decisions that was made after the assessment regarding support was not followed up and were not executed:

It is frustrating that you as a parent have to argue all the time.”

Parents in one case also report that the child did not feel comfortable in going to assessment.

One dilemma one parent mentions is a disappointment not to have received any document (diagnosis) confirming the child has dyslexia:

“The special education teacher didn’t want to put a diagnosis. It would be better for us to have a document, our son would get help more easily.”

3. Did you learn something as a result of the assessment?

Three parents report that they learned more about the need to push school into action:

“You can’t presume that everything is ok just because you don’t hear anything and as a parent you have to be more active and work harder at home. “

Two parents report a clearly positive experience, involving them learning a lot about the childs way of learning:

“ We now know how to reach our son, and how to support him.”

4. Has the learning environment changed as a result of the assessment?

Four out of five parents describe that the learning environment inside the regular classroom has not been adjusted to any substantial degree. In one case there has been a substantial change also in the learning environment in the regular classroom.

However, three parents report that their children have received extra support, mainly in the area of reading and writing, outside of the regular classroom through special education.

One parent expresses that their child changed to another school, and the parents had to push for meetings where the information from the earlier assessment could be shared and actualized:

“After the assessment he began the secondary school, with more subjects and demands. We don´t think that he got enough support there.”

One parent tells that the teachers were clearly not ready to follow the information from the assessment, more than for a short while. The recommendations were not followed up and therefore fell out of the agenda:

”The present teacher has not considered the recommendations very much.”

5. Has your understanding of your childs needs changed as a result of the assessment?

One parent describes that the assessment rather confirmed what they already knew. Four parents express that the assessment has changed their understanding of the needs of their son to some degree:

“Earlier we thought he might be lazy and stubborn. We don’t need to nag him to do things, for example homework, which he earlier tried to avoid.”

“When we got feedback from the assessment we realized that he needs more support. Now he himself understands the value of support and the importance of training. There is a flow in life right now.”

6. Was there something lacking in the assessment process?

Three parents declare that they wish that school health services would have taken a more active part in the follow-ups after the assessment and that the needs of their child had been more focused on. One of these parents express that the first assessment that was done did not lead to anything substantial due to lack of follow-ups. All three parents are also in varying degree critical that there seems to be a gap between different organisations with different goals and rules:

”The principal has his money and limitations, the school health services have their competence and resources, and then there is money from the government for children with mental retardation. There is no coordination between these actors”

One parent expresses that they wanted a document with a formal diagnosis.

One parent declare that the teachers don´t seem to follow recommendations from the assessment.

Interviews with teachers

1. What was the overall benefit from the assessment?