Early Detection of Developmental Needs
From 1991 – 2002, assessment and diagnosis for early identification of developmental needs was set up across key medical institutions.
Since 2010, KKH and NUH CDUs offer parent/caregiver training and therapy services supporting children awaiting Early Intervention services.
Various government-funded service providers including CDU @ KKH (Child Development Unit at KK Women’s and Children Hospital), CDU @ NUH (National University of Singapore) and the Child Guidance Clinic @ IMH (Institute of Mental Health) provided assessment and diagnosis for early identification of disabilities.
- These therapy services are at satellite CDUs (Health Promotion Board, Rivervale Crescent, Keat Hong Community Club and Jurong Medical Centre).
In 2002, the then-Ministry of Community Development and Sports (MCDS) launched the Integrated Child Care Programme (ICCP).
- Under the ICCP, selected preschools are equipped with additional staff to support children who require low levels of early intervention support, and provide a preschool programme for these children to learn, play and socialise alongside typically developing children. ICCP is currently provided in 14 centres.
In 2003, the then-MCDS launched the Early Intervention Programme for Infants and Children (EIPIC).
In 2008, the EIPIC Support Grant was implemented.
- Prior to 2003, the voluntary sector provided a range of programmes. With the launch of the EIPIC in 2003, children who are 6 years old and below, who require medium to high levels of early intervention support, could receive subsidised developmental and therapy services, equipping them with improved motor, communication, social, self-help and cognitive skills.
- Today, 21 early intervention centres across Singapore deliver EIPIC.
In 2011, MSF launched the Enhanced Pilot for Private Intervention Providers (PPIP).
- It aimed to make EIPIC more affordable, so that EIPIC would be accessible to all children.
- NCSS and MCYS contributed a total of $3.6m while extending the EIPIC Support Grant until 1 July 2010. In 2009, EIPIC providers were able to tap on the fund for further assistance.
- Since 1 July 2010, as a supplement to the grant, MCYS introduced a fixed subsidy of $300 per month for all citizen children to help defray the costs of care.
- For low-income families whose per capita monthly household income is below $1,450, they receive additional means-tested subsidies.
In 2013, MSF worked with KKH, NUH and various pre-schools to launch the Development Support-Learning Support (DS-LS) programme.
- The PPIP provides private sector operators who provide developmental and therapy services for preschool-aged children who require medium to high levels of early intervention support.
- There are currently 10 PPIP providers.
In 2014, MSF enhanced the affordability of EIPIC programmes.
- Before the development of the DS-LS programme, Lien Foundation and KKH had worked with 25 PAP Community Foundation (PCF) centres to pilot the Mission: I’mPossible (MIP) programme, which provided early identification and intervention services for pre-school children who require low levels of early intervention support, within their preschools.
- The DS-LS programme grew from the MIP programme and has been scaled up subsequently. It supports preschool children (K1 and K2 levels) who require low levels of early intervention support, and aims to equip children with developmentally appropriate skills to optimise their developmental outcomes.
- In 2020, around 600 preschools offered the DS-LS programme.
- Base subsidies for EIPIC increased from $300 to $500, and means tested subsidies covered households up to $4,600 per capita household income, up from $3,000 per capita household income previously.
- In 2019, out-of-pocket expenses for EI services were lowered across all early intervention programmes for most income groups, with reductions averaging between 30% to 70% depending on the early intervention programme.
Development of the EI sector manpower
Then-MCYS and NCSS worked with IHLs to
build up local expertise of skilled manpower and ensure sufficient training
places to expand the supply of trained manpower.
- Since 2006, MCYS and NCSS worked with Ngee Ann Polytechnic (NP) to introduce the Advanced Diploma in Early Childhood Intervention (ADECI) and a certificate in Early Childhood Intervention (CECI) for teachers and teaching assistants.
- MCYS and NCSS engaged Ngee Ann Polytechnic in 2006 to conduct an Advanced Diploma in Early Childhood Intervention (Special Needs), otherwise known as ADESN, to meet the shortage of trained professionals in early childhood intervention. This diploma was to further develop early childhood educators and upskill those already working in EIPIC centres.
- The ADESN had previously undergone two reviews, to meet the continuously changing training needs of the sector.
- In 2021, upon recognising the need for greater porosity in the early intervention sector, the National Institute of Early Childhood Development (NIEC), alongside members of the Skillsfuture Tripartite Taskforce (STT), made further refinements to the ADESN's curriculum. The course was subsequently renamed specialist Diploma in Early Childhood Intervention (Special Needs) (SDESN).
- The launch of the Development Support Programme in 2013 had shed light on the importance of Learning Support Educators (LSEds) in ensuring the programme's success. As a result, Ngee Ann Polytechnic (NP) was invited to develop the Specialist Diploma in Early Childhood Learning Support (SDELS) jointly with MSF, alongside the Development Support Programme consultancy team. This course aims to help equip early childhood educators to take on a more specialised role to support children with developmental needs.
Enhanced the network of touchpoints to ensure timely and effective detection of developmental needs in children
In 2017, the HealthHub app was enhanced to help parents track their children’s developmental milestones.
In January 2019, MOH, in collaboration with MOE, IMH, KKH and NUH, issued a referral protocol for children with developmental delays to all registered medical practitioners.
- The app contains an electronic version of each child’s Health Booklet, and contains a checklist and growth charts so that parents can conveniently track the developmental milestones of their children. The app also sends reminders to parents to review the developmental checklist and make immunisation appointments.
- Nurses at KKH, NUH, polyclinics and private hospitals, as well as the Health Promotion Board’s Health Ambassadors, are trained to use the e-Health Booklet so that they may assist parents.
In January 2020, the Integrated Maternal and Child Wellness Hub Pilot was launched at Punggol Polyclinic.
- Primary care physicians can refer pre-school children to the Child Development Programme while school-aged children can be referred to either schools (including the school psychologist), KKH or NUH general paediatric specialist outpatient clinics for further assessment.
In July 2020, MOH issued a set of Guidance on Childhood Developmental Screening (CDS) for all medical practitioners.
- The Hub offers enhanced child developmental screening and other developmental and maternal services.
- The Guidance on CDS provides practical information to clinicians on monitoring and referral for developmental delays in children aged 0-6 years to ensure timely referrals for further evaluation and any necessary early intervention.
- MOH also worked with the College of Family Physicians Singapore to organise a refresher course on CDS for primary care clinicians in July 2020.
- Since end-2020, the clinical practice guidance has been adopted across primary care institutions, including GP clinics.
Early intervention programmes have been made more affordable and are better tailored to the varied needs of children as they develop over time
In 2019, MSF launched two new early intervention programmes to ensure that early intervention is better tailored to the varied needs of children:
In 2019, to make early intervention services more affordable for families of children with developmental needs, MSF i) enhanced early intervention subsidies and ii) broadened the income criteria for means-tested subsidies so that more families would qualify.
- EIPIC Under-2s programme: Serves children under two years old who require medium to high levels of early intervention support. The programme emphasises the training of parents and caregivers so they can effectively carry out intervention strategies in the child's daily routines within the home setting. Such strategies embed learning opportunities throughout the children's daily lives, and lead to more sustainable outcomes. At the age of two, the children will transit to the EIPIC@Centre programme. There are currently 19 early intervention centres providing EIPIC Under-2s, with 2 more EI centres coming on board by early 2021.
- Development Support Plus (DS-Plus) programme: Provides intervention to children up to age six who have made sufficient progress in EIPIC, to transit to receiving intervention in a pre-school setting. Early intervention professionals from early intervention centres work with the child in his/her pre-school twice a week on average, co-teaching the child alongside the pre-school teacher.
- As a result, out-of-pocket expenses for early intervention services were lowered across all early intervention programmes for most income groups from 1 April 2019, with reductions averaging between 30% to 70% depending on the early intervention programme.
- After the enhanced subsidies, fees for children who are Singaporean citizens range from $5 to $430 per month.
Enhancing Inclusion and Support for Children with Developmental Needs in Preschools
In 2019, MSF launched the cross-sectoral Inclusive Preschool Workgroup (IPWG), involving people, private and public sector partners to study and develop recommendations to better support children with developmental needs in preschools.
ECDA is also working with training partners such as the National Institute of Early Childhood Development (NIEC) to deepen inclusive practices in both pre-employment training and Continuing Professional Development (CPD) courses for early childhood educators. Efforts include:
- The workgroup is currently co-chaired by Minister for State for Social and Family Development and Education Sun Xueling and Associate Dean (Education and Research) Kenneth Poon from the Institute of Education (NIE). Prior to August 2020, the workgroup was co-chaired by former-Senior Parliamentary Secretary (Social and Family Development, and Education) Associate Professor Muhammed Faishal Ibrahim.
- Several of the IPWG's recommendations were announced at the Ministry of Social and Family Development Committee of Supply debate in March 2021, and will be implemented over the next few years;
- Working towards every preschool appointing one of its staff as an Inclusion Coordinator (ICO) beginning in the second half of 2023;
- Expanding the Development Support-Learning Support (DS-LS) and Developmental Support Plus (DS-Plus) programmes to more preschools, to support children requiring low levels of early intervention support;
- Piloting a new Inclusive Support Programme (InSP) which integrates early childhood and early intervention services at preschools for children who require medium levels of early intervention support;
- Studying integration opportunities for children who require high levels of early intervention support and remain better served at separate specialised early intervention settings;
- Enhancing training for early childhood and early intervention professionals, eg. introducing a new Certificate in Inclusive Practice.
- The Workgroup released its recommendations in April 2021.
- Working with NIEC to infuse differentiated teaching strategies into pre-service early childhood programmes where relevant, so that supporting children with development needs is viewed as a continuum in mainstream teaching.
- Launch of a Continuing Professional Development (CPD) roadmap with "inclusive practices" as one of the key focal areas,and introduce new CPD programmes related to this focal area.
- This will help to strengthen early childhood educators' capabilities to work with children with diverse learning needs in their classrooms.